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General NPI Number Information
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NPI Number | 1790453561
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Entity Type | Organization
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Legal Business Name | CROSS HEART CARE LLC
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Dates
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Enumeration Date | 09/05/2021
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 848 NORTH 4TH STREET
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City | FORT SUMNER
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State | NM
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Zip | 88119-9411
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Country | US
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Telephone | 575-355-2273
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 928
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City | FORT SUMNER
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State | NM
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Zip | 88119-0928
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Country | US
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Telephone | 575-355-2273
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Fax |
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Authorized Official
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Title or Position | OWNER PROVIDER
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Name | MARY MOLLY KENYON
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Credential | APRN-CNP
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Telephone | 575-355-2273
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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 |
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License Number State |
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