Core Primarycare Clinic LLC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

Legal business name

CORE PRIMARYCARE CLINIC LLC

Practice address

1557 Monte Vista Ave
Las Cruces, NM 88001-5731

Phone

(575) 571-6946

NPI assigned

Mar 18, 2024

Organization subpart

No

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

Authorized official

Name

Ekeoma I Cooper, MD

Title

Owner

Phone

(575) 571-6946

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1710720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722297600000",
    "number": "1568221885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 NORTHWEST DR STE 350",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751501364",
            "telephone_number": "575-571-6946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1557 MONTE VISTA AVE",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880015731",
            "telephone_number": "575-571-6946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORE PRIMARYCARE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-18",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "EKEOMA",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "575-571-6946",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nathan Cordero
• Angelo Cordova, LCSW
• Dolores Cordova, CFNP
• Kathleen Joyce Cordova, D.D.S.
• Core Mentalhealth Clinic LLC
• Tabatha Coreas-Dodson
• Corey Vas Counseling Inc
• Elias Cornejo
• Javier Cornejo Jr., CPSW
• Justice Cornejo

• Gerontology Nurse Practitioner in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Gerontology Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; 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.