MEDICARE: MRS. BREJETTE EMERY BS, CHW, CCSS,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency		NM
2	172V00000X	Community Health Worker		NM

General Provider Information

NPI Number	:	1902757479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BREJETTE EMERY BS, CHW, CCSS,

Provider Business Mailing Address
First Line	:	10651 VIRGO ST NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-3661
Country	:	US
Telephone Number	:	505-585-4366
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 CENTRAL AVE SW STE 1500
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-3298
Country	:	US
Telephone Number	:	505-369-1731
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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