Jean L Dutra, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

4480 Issued in NM

Practice address

318 Abalone Loop
Mescalero Ludian Hospital
Mescalero, NM 88340-0210

Phone

(505) 464-4441

Fax

(505) 464-4422

NPI assigned

Sep 21, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Ms. Jean D Hickey Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124127501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3727 DRIFTWOOD AVE",
            "city": "ALAMOGORDO",
            "state": "NM",
            "postal_code": "883103727",
            "telephone_number": "505-437-6162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "318 ABALONE LOOP",
            "address_2": "MESCALERO LUDIAN HOSPITAL",
            "city": "MESCALERO",
            "state": "NM",
            "postal_code": "883400210",
            "telephone_number": "505-464-4441",
            "fax_number": "505-464-4422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUTRA",
        "first_name": "JEAN",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "029534",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NM",
            "license": "4480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEAN",
            "last_name": "HICKEY",
            "middle_name": "D",
            "prefix": "MS.",
            "credential": "RPH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Charlotte Pearl Briggs, RN
• Valerie Vanaya Comanche, BMS
• Aaron Contreras, PHARMD
• Faith S Duran, BMS
• Suzanna Duran, MT(ASCP)
• Autumn Lynn Enjady
• Pedro Ivan Espinoza
• Carol Esquibel
• Sandy Etigson
• Pamela Rose Evans

• Pharmacist in Mescalero, NM
• Providers in Mescalero, NM by specialty
• Pharmacist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.