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General NPI Number Information
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NPI Number | 1801767520
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Entity Type | Individual
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Provider Name | KELLIE LYNN CORTEZ BSN RN
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Gender | Female
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Dates
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Enumeration Date | 09/16/2025
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 100 FRANKLIN STREET
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City | GRADY
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State | NM
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Zip | 88120
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Country | US
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Telephone | 575-357-2192
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Fax | 575-357-2192
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Provider Business Mailing Address
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Address Line | PO BOX 847
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City | PORTALES
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State | NM
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Zip | 88130-0847
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Country | US
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Telephone | 575-562-4458
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Fax | 575-562-4460
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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 | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | 435940
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License Number State | NM
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