Individual
JACQUELINE NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1600 N MAIN AVE, LOVINGTON, NM 88260-2830
(575) 396-6611
Mailing address
1600 N MAIN AVE, LOVINGTON, NM 88260-2830
(575) 396-6611
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP-03114
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
84824549
—
NM
Enumeration date
10/20/2016
Last updated
08/22/2022
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