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General NPI Number Information
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NPI Number | 1376092981
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Entity Type | Individual
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Provider Name | JESSICA SOUCY FNP
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Gender | Female
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 3080 BRELAND DR
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City | LAS CRUCES
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State | NM
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Zip | 88003
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Country | US
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Telephone | 575-646-1512
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Fax | 575-646-6428
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Provider Business Mailing Address
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Address Line | P.O. BOX 30001 MSC 3529
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City | LAS CRUCES
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State | NM
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Zip | 88003-8001
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Country | US
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Telephone | 575-646-1512
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Fax | 575-646-6428
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP-02977
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License Number State | NM
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