| NPI | 1306609763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH TACKETT Credentialing COO Rdinator 575-399-3468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-01-30 |
| Last Update Date | 2024-01-30 |