Individual
JINA VICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
303 E WASHINGTON AVE, TUCUMCARI, NM 88401-3873
(575) 461-4464
Mailing address
303 E WASHINGTON AVE, TUCUMCARI, NM 88401-3873
(575) 461-4464
(575) 461-4474
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R14987
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000Z6045
—
NM
01
—
00NM009J49
BLUE CROSS BLUE SHIELD
NM
01
—
201022182
PRESBYTERIAN SALUD
NM
01
—
53794
MOLINA
NM
01
—
P00061317
RAILROAD MEDICARE
NM
Enumeration date
09/13/2005
Last updated
07/12/2010
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