Provider Demographics
NPI:1871884023
Name:SOUTHWEST NURSE PRACTITIONERS
Entity type:Organization
Organization Name:SOUTHWEST NURSE PRACTITIONERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-BC/ PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:PADGETT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:505-716-8800
Mailing Address - Street 1:3401 N BUTLER AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6866
Mailing Address - Country:US
Mailing Address - Phone:505-716-8800
Mailing Address - Fax:
Practice Address - Street 1:3401 N BUTLER AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6866
Practice Address - Country:US
Practice Address - Phone:505-716-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR55878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty