Provider Demographics
NPI:1780778159
Name:BELCHER, CONSTANCE C (CFNP)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:C
Last Name:BELCHER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 FRED DAUGHERTY AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-8615
Mailing Address - Country:US
Mailing Address - Phone:575-760-0160
Mailing Address - Fax:575-762-1676
Practice Address - Street 1:2513 FRED DAUGHERTY AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-8615
Practice Address - Country:US
Practice Address - Phone:575-760-0160
Practice Address - Fax:575-762-1676
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR19258207Q00000X
NMCNP00289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR8625Medicaid
NM00R8625Medicaid
NMA102492Medicare PIN
S49050Medicare UPIN