Provider Demographics
NPI:1326441346
Name:CHACON, LADONNA LEE (AGPCNP-C)
Entity Type:Individual
Prefix:
First Name:LADONNA
Middle Name:LEE
Last Name:CHACON
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2799 QUAY ROAD 64
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401-9629
Mailing Address - Country:US
Mailing Address - Phone:575-576-2708
Mailing Address - Fax:
Practice Address - Street 1:1302 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-2508
Practice Address - Country:US
Practice Address - Phone:575-461-2200
Practice Address - Fax:575-461-2213
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-04
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR32046163W00000X
NMCNP-02602363LP2300X, 363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology