Healthcare Provider Details

I. General information

NPI: 1861274599
Provider Name (Legal Business Name): BLUE SKY PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 JUAN TABO BLVD NE STE D
ALBUQUERQUE NM
87111-3979
US

IV. Provider business mailing address

4001 JUAN TABO BLVD NE STE D
ALBUQUERQUE NM
87111-3979
US

V. Phone/Fax

Practice location:
  • Phone: 505-738-6989
  • Fax: 505-355-1394
Mailing address:
  • Phone: 505-738-6989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STELA MIDDLETON
Title or Position: OWNER
Credential: CNP
Phone: 505-633-7898