Organization
CORE PRIMARYCARE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EKEOMA I COOPER MD (OWNER)
(575) 571-6946
Entity
Organization
Contact information
Practice address
1557 MONTE VISTA AVE, LAS CRUCES, NM 88001-5731
(575) 571-6946
Mailing address
6500 NORTHWEST DR STE 350, MESQUITE, TX 75150-1364
(575) 571-6946
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
03/18/2024
Last updated
07/30/2024
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