Provider Demographics
NPI:1801172150
Name:BLEVINS, CARRIE NICHOLE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:NICHOLE
Last Name:BLEVINS
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 1:831 CORTO
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-1094
Mailing Address - Country:US
Mailing Address - Phone:575-691-9573
Mailing Address - Fax:
Practice Address - Street 1:805 W. KANSAS
Practice Address - Street 2:
Practice Address - City:JAL
Practice Address - State:NM
Practice Address - Zip Code:88252
Practice Address - Country:US
Practice Address - Phone:575-395-3400
Practice Address - Fax:575-395-2235
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01862363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2022092898OtherPMHNP BOARD CERTIFICATION
NM10708081Medicaid
NMF0911364OtherNP BOARD CERTIFICATION