Provider Demographics
NPI:1922106939
Name:MOFFATT, BILLYE (CNFP)
Entity Type:Individual
Prefix:MS
First Name:BILLYE
Middle Name:
Last Name:MOFFATT
Suffix:
Gender:F
Credentials:CNFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:SAN FIDEL
Mailing Address - State:NM
Mailing Address - Zip Code:87049
Mailing Address - Country:US
Mailing Address - Phone:505-552-5300
Mailing Address - Fax:505-552-5490
Practice Address - Street 1:ACOMA CANONCITO LAGUNA INDIAN
Practice Address - Street 2:80 B VETERANS
Practice Address - City:ACOMA
Practice Address - State:NM
Practice Address - Zip Code:87034-8703
Practice Address - Country:US
Practice Address - Phone:505-552-5300
Practice Address - Fax:505-552-5490
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP01035363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH3451Medicaid
PHS000Medicare UPIN
NMH3451Medicaid