Healthcare Provider Details

I. General information

NPI: 1033706924
Provider Name (Legal Business Name): BEEWELL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/25/2020
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 CARLISLE BLVD NE # C
ALBUQUERQUE NM
87107-4808
US

IV. Provider business mailing address

8226 MENAUL BLVD NE # 144
ALBUQUERQUE NM
87110-4614
US

V. Phone/Fax

Practice location:
  • Phone: 505-544-2366
  • Fax: 505-581-6988
Mailing address:
  • Phone: 505-544-2366
  • Fax: 505-581-6988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KONTASHA SHAMIKA WISE
Title or Position: CNP, PMHNP-BC
Credential:
Phone: 505-554-8315