Active NPI
Linda Elaine Wylie, CFNP
- Family Nurse Practitioner
- Ribera, NM
National Provider Identifier
1669618484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- CNP00413
- Practice address
- 275 New Mexico 3
Ribera, NM 87560 - Phone
- (575) 421-1113
- Fax
- (575) 421-2943
- NPI assigned
- Dec 29, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | CNP00413 | NM | Primary |
| Family Nurse Practitioner | 363LF0000X | R23726 | NM |
Addresses
Primary practice location
275 New Mexico 3
Ribera, NM 87560
Mailing address
PO Box 158
538 N. Paseo de Onate
Espanola, NM 87532-0158
Phone (505) 753-7218
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NM400316 | Other | NM | MEDICARE PTAN |
| 44256779 | 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)
- Enrolled
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R23726 | NM | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| El Centro Family Health | Past | Accepting new patients | |
| El Centro Family Health | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Wagon Mound, NM
- NPI 1538324223
-
- Federally Qualified Health Center (FQHC)
- Ribera, NM
- NPI 1760647457
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1230508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372982400000",
"number": "1669618484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 158",
"address_2": "538 N. PASEO DE ONATE",
"city": "ESPANOLA",
"state": "NM",
"postal_code": "875320158",
"telephone_number": "505-753-7218",
"fax_number": "505-753-5815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "275 NEW MEXICO 3",
"city": "RIBERA",
"state": "NM",
"postal_code": "87560",
"telephone_number": "575-421-1113",
"fax_number": "575-421-2943"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYLIE",
"first_name": "LINDA",
"middle_name": "ELAINE",
"credential": "CFNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-12-29",
"last_updated": "2013-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NM",
"license": "CNP00413",
"primary": true
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NM",
"license": "R23726",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "NM400316",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "44256779",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ribera, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 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.