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General NPI Number Information
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NPI Number | 1568712842
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Entity Type | Individual
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Provider Name | WILLIAM JAY SALLS CNP
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Gender | Male
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 36 SOUTH LATIR ROAD
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City | QUESTA
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State | NM
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Zip | 87556
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Country | US
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Telephone | 575-770-6865
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Fax | 833-450-5253
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Provider Business Mailing Address
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Address Line | PO BOX 638
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City | QUESTA
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State | NM
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Zip | 87556-0638
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Country | US
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Telephone | 575-586-2014
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Fax | 833-450-5253
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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 | C-APN.0000331-C-NP
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP-02608
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License Number State | NM
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