Provider Demographics
NPI:1962714410
Name:CLOVIS QUICKCARE LLC
Entity type:Organization
Organization Name:CLOVIS QUICKCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CYPHERT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:575-769-2533
Mailing Address - Street 1:2000 W 21ST ST STE E3
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4093
Mailing Address - Country:US
Mailing Address - Phone:575-769-2533
Mailing Address - Fax:575-769-1735
Practice Address - Street 1:2000 W 21ST ST STE E3
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4093
Practice Address - Country:US
Practice Address - Phone:575-769-2533
Practice Address - Fax:575-769-1735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0383007363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1982601498OtherINDIVIDUAL NPI #