Healthcare Provider Details

I. General information

NPI: 1275116667
Provider Name (Legal Business Name): ANNA MIKESKY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 JEFFERSON ST NE
ALBUQUERQUE NM
87109-3473
US

IV. Provider business mailing address

5411 JEFFERSON ST NE
ALBUQUERQUE NM
87109-3473
US

V. Phone/Fax

Practice location:
  • Phone: 855-772-8847
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6191
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number5806
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number40229
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY-2025-0138
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: