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General NPI Number Information
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NPI Number | 1871884023
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Entity Type | Organization
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Legal Business Name | SOUTHWEST NURSE PRACTITIONERS
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Dates
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Enumeration Date | 04/22/2011
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Last Update Date | 04/22/2011
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Provider Practice Location Address
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Address Line | 3401 N BUTLER AVE SUITE 105
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City | FARMINGTON
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State | NM
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Zip | 87401-6866
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Country | US
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Telephone | 505-716-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 3401 N BUTLER AVE SUITE 105
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City | FARMINGTON
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State | NM
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Zip | 87401-6866
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Country | US
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Telephone | 505-716-8800
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Fax |
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Authorized Official
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Title or Position | FNP-BC/ PRESIDENT, CEO
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Name | JODI PADGETT
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Credential | FNP-BC
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Telephone | 505-716-8800
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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 | R55878
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License Number State | NM
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