Provider Demographics
NPI:1770273625
Name:GENTRY, DUSTY LAUREN (FNP-C)
Entity type:Individual
Prefix:
First Name:DUSTY
Middle Name:LAUREN
Last Name:GENTRY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-8216
Mailing Address - Country:US
Mailing Address - Phone:505-317-7773
Mailing Address - Fax:855-844-8611
Practice Address - Street 1:101 N 6TH ST
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-8216
Practice Address - Country:US
Practice Address - Phone:505-317-7773
Practice Address - Fax:855-844-8611
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM73468363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily