Phyllis Diane Morehead, RN
Individual provider Active NPI Registered Nurse · Dulce, NM
NPI 1134490790 · NPPES record last updated Feb 2, 2012
Key facts
- NPI
- 1134490790
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 1091032 (KY)
- Practice address
- 500 North Mundo
Dulce, NM 87528-0187 - Phone
- (575) 759-3291
- NPI assigned
- Jan 13, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1091032 | KY | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dulce Health Center | Past |
Accepting new patients | |
| Jicarilla IHS Pharmacy | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 1091032 | KY | Yes |
Addresses
Primary practice location
500 North Mundo
Dulce, NM 87528-0187
Mailing address
P O Box 187
Dulce, NM 87528-0187
Phone (575) 759-7237
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HSZ196 | Other | NM | MEDICARE PART B |
| 000K3526 | Medicaid | NM |
Other names
- Phyllis Diane Hawkins
Other providers in Dulce, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 2, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.