Healthcare Provider Details

I. General information

NPI: 1043124795
Provider Name (Legal Business Name): JORDAN PAREY PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2660
US

IV. Provider business mailing address

4401 MORRIS ST NE APT 247
ALBUQUERQUE NM
87111-3734
US

V. Phone/Fax

Practice location:
  • Phone: 505-340-6154
  • Fax: 505-702-8171
Mailing address:
  • Phone: 505-289-2200
  • Fax: 505-702-8171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number19000412
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: