Tony Lee Clark, NP
Individual provider Active NPI Family Nurse Practitioner · Hatch, NM
NPI 1659869659 · NPPES record last updated Jan 11, 2024
Key facts
- NPI
- 1659869659
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 75659 (NM)
- Practice address
- 610 Red Hills Road
Hatch, NM 87937 - Phone
- (575) 520-0292
- NPI assigned
- Apr 25, 2018
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 75659 | NM | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Las Cruces School District No. 2 | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 75659 | NM | Yes |
Addresses
Primary practice location
610 Red Hills Road
Hatch, NM 87937
Mailing address
4542 Montgomery
Albuquerque, NM 87109
Phone (575) 621-3940
Other providers in Hatch, NM
- Jennie Barela
- Ben Archer Health Center
- Ben Archer Health Center
- Laura Christine Boyd
- Neysla Cisneros
- Cristina Davis
- Patrick B Doherty
- Julia Escarsega
- America Garcia Cervantes
- Gloria Garcia
All providers in Hatch, NM · Family Nurse Practitioner in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2024. 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.