MEDICARE: STRONG ROOTS FAMILY CLINIC LLC

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

General Provider Information

NPI Number	:	1043164254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRONG ROOTS FAMILY CLINIC LLC

Provider Business Mailing Address
First Line	:	3113 NATIONAL PARKS HWY STE 3
Second Line	:
City	:	CARLSBAD
State	:	NM
Zip	:	88220-5697
Country	:	US
Telephone Number	:	575-234-0211
Fax Number	:

Provider Business Practice Location Address
First Line	:	3113 NATIONAL PARKS HWY STE 3
Second Line	:
City	:	CARLSBAD
State	:	NM
Zip	:	88220-5697
Country	:	US
Telephone Number	:	575-234-0211
Fax Number	:

Authorized Official
Title or Position	:	FAMILY NURSE PRACTITIONER
Name	:	NICOLE DYAN CHAVEZ
Credential	:	FNP-C
Telephone Number	:	515-210-3723

Provider Enumeration Date	:	02/24/2026
Last Update Date	:	02/24/2026

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Directions to “STRONG ROOTS FAMILY CLINIC LLC ” Practice Location

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