Active NPI
Carol Connelly, CNP
- Pediatric Nurse Practitioner
- Farmington, NM
National Provider Identifier
1609969245
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- R39967
- Practice address
- 407 S Schwartz Ave
Ste 102
Farmington, NM 87401-5925 - Phone
- (505) 609-6700
- Fax
- (505) 609-6701
- NPI assigned
- Oct 2, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | R39967 | NM | Primary |
Addresses
Primary practice location
407 S Schwartz Ave
Ste 102
Farmington, NM 87401-5925
Mailing address
PO Box 6210
Farmington, NM 87499-6210
Phone (505) 609-2258
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000Z0447 | Medicaid | NM |
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
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R39967 | NM | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365552000000",
"number": "1609969245",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6210",
"city": "FARMINGTON",
"state": "NM",
"postal_code": "874996210",
"telephone_number": "505-609-2258",
"fax_number": "505-609-2259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "407 S SCHWARTZ AVE",
"address_2": "STE 102",
"city": "FARMINGTON",
"state": "NM",
"postal_code": "874015925",
"telephone_number": "505-609-6700",
"fax_number": "505-609-6701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNELLY",
"first_name": "CAROL",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-02",
"last_updated": "2013-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "NM",
"license": "R39967",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000Z0447",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Farmington, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.