Active NPI
Dalisa J Wright, CLMT
- Specialist
- Clovis, NM
National Provider Identifier
1104004514
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 57752
- Practice address
- 116 Prairieview Dr
Clovis, NM 88101-4234 - Phone
- (505) 763-5200
- NPI assigned
- Feb 7, 2008
- Last updated
- Feb 7, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 57752 | NM | Primary |
Addresses
Primary practice location
116 Prairieview Dr
Clovis, NM 88101-4234
Mailing address
2508 N Prince St
PMB 95
Clovis, NM 88101-4460
Phone (505) 763-5200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57752 | NM | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202342400000",
"number": "1104004514",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2508 N PRINCE ST",
"address_2": "PMB 95",
"city": "CLOVIS",
"state": "NM",
"postal_code": "881014460",
"telephone_number": "505-763-5200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "116 PRAIRIEVIEW DR",
"city": "CLOVIS",
"state": "NM",
"postal_code": "881014234",
"telephone_number": "505-763-5200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WRIGHT",
"first_name": "DALISA",
"middle_name": "J",
"name_prefix": "Ms.",
"credential": "CLMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-02-07",
"last_updated": "2008-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NM",
"license": "57752",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clovis, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.