Glynda Mae Dallas, CNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

R47073 Issued in NM

Practice address

2000 W 21St St
#A-1
Clovis, NM 88101-4087

Phone

(575) 762-8055

Fax

(575) 763-3351

NPI assigned

May 17, 2006

Last updated

Feb 29, 2012By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Roosevelt County Special Hospital District

  dba Roosevelt General Hospital

  • General Acute Care Hospital
  • Portales, NM
  • NPI 1073517058
  Medicare reassignment NPD
• Roosevelt County Special Hospital District

  dba RGH-Internal Medicine Group

  • Family Medicine Physician
  • Portales, NM
  • NPI 1093801292
  NPD

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330473600000",
    "number": "1255383261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 W 21ST ST",
            "address_2": "SUITE A-1",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881014087",
            "telephone_number": "575-762-8055",
            "fax_number": "575-763-3351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 W 21ST ST",
            "address_2": "#A-1",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881014087",
            "telephone_number": "575-762-8055",
            "fax_number": "575-763-3351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALLAS",
        "first_name": "GLYNDA",
        "middle_name": "MAE",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-17",
        "last_updated": "2012-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NM",
            "license": "R47073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39038",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Curbside Wellness Clinic LLC
• Curry Emergency Group LLC
• Ashley N Curtis, RN
• Tamara Lynn Curtis, LMT
• Claresole Cutting, FSS
• Daniel & Max LLC
• Kathleen M Daniel
• Colton Ray Dant, PHARMD, RPH
• Danielle Emily Davey
• Alexjandro C Daviano, DN, DO, DRPH, MS,MPH

• Nurse Practitioner in Clovis, NM
• Providers in Clovis, NM by specialty
• Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.