Provider Demographics
NPI:1326441346
Name:CHACON, LADONNA LEE (AGPCNP-C)
Entity type:Individual
Prefix:
First Name:LADONNA
Middle Name:LEE
Last Name:CHACON
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 E MIEL DE LUNA AVE
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401-3828
Mailing Address - Country:US
Mailing Address - Phone:575-461-7100
Mailing Address - Fax:575-461-7101
Practice Address - Street 1:402 E MIEL DE LUNA AVE
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-3828
Practice Address - Country:US
Practice Address - Phone:575-461-7100
Practice Address - Fax:575-461-7101
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-04
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR32046163W00000X
NMCNP-02602363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology