Provider Demographics
NPI:1154113686
Name:MARTELL, KARLIE LYNN
Entity type:Individual
Prefix:
First Name:KARLIE
Middle Name:LYNN
Last Name:MARTELL
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PASEO VLG
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-3144
Mailing Address - Country:US
Mailing Address - Phone:575-214-4712
Mailing Address - Fax:
Practice Address - Street 1:3 PASEO VLG
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-3144
Practice Address - Country:US
Practice Address - Phone:575-214-4712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker