MEDICARE: GAYLE RAYE GLENN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	84397	NM

General Provider Information

NPI Number	:	1013802156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLE RAYE GLENN NP

Provider Business Mailing Address
First Line	:	111 N PEARL ST
Second Line	:
City	:	DEMING
State	:	NM
Zip	:	88030-3835
Country	:	US
Telephone Number	:	575-571-2725
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 N PEARL ST
Second Line	:
City	:	DEMING
State	:	NM
Zip	:	88030-3835
Country	:	US
Telephone Number	:	575-517-2725
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2025
Last Update Date	:	03/24/2026

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Directions to “ GAYLE RAYE GLENN NP” Practice Location

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