Provider Demographics
NPI:1831818921
Name:STOOPS, ROBERT (CNP)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:STOOPS
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:STOOPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNP
Mailing Address - Street 1:1 FOSTER LANE
Mailing Address - Street 2:
Mailing Address - City:RESERVE
Mailing Address - State:NM
Mailing Address - Zip Code:87830
Mailing Address - Country:US
Mailing Address - Phone:575-533-6456
Mailing Address - Fax:575-533-6767
Practice Address - Street 1:1 FOSTER LANE
Practice Address - Street 2:
Practice Address - City:RESERVE
Practice Address - State:NM
Practice Address - Zip Code:87830
Practice Address - Country:US
Practice Address - Phone:575-533-6456
Practice Address - Fax:575-533-6767
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM69417363L00000X, 363LF0000X
NMR65940163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice