Provider Demographics
NPI:1760995609
Name:PADEN, JODY (RN, BSN)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:PADEN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 E AMAZON ST
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-9211
Mailing Address - Country:US
Mailing Address - Phone:575-468-6516
Mailing Address - Fax:
Practice Address - Street 1:1000 N AVENUE M
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-5226
Practice Address - Country:US
Practice Address - Phone:575-356-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-70601163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool