Provider Demographics
NPI:1801767520
Name:CORTEZ, KELLIE LYNN (BSN RN)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:LYNN
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 847
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-0847
Mailing Address - Country:US
Mailing Address - Phone:575-562-4458
Mailing Address - Fax:575-562-4460
Practice Address - Street 1:100 FRANKLIN STREET
Practice Address - Street 2:
Practice Address - City:GRADY
Practice Address - State:NM
Practice Address - Zip Code:88120
Practice Address - Country:US
Practice Address - Phone:575-357-2192
Practice Address - Fax:575-357-2192
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM435940163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool