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General NPI Number Information
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NPI Number | 1922264902
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Entity Type | Individual
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Provider Name | SHERRY RAYNE MOYA FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/30/2008
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 300 W COUNTRY CLUB RD STE 230
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City | ROSWELL
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State | NM
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Zip | 88201-5240
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Country | US
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Telephone | 575-622-1411
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Fax | 575-624-5630
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Provider Business Mailing Address
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Address Line | 300 W COUNTRY CLUB RD STE 230
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City | ROSWELL
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State | NM
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Zip | 88201-5240
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Country | US
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Telephone | 575-622-1411
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Fax | 575-624-5630
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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 | RN173415
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License Number State | GA
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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 | R67236
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License Number State | NM
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