Healthcare Provider Details

I. General information

NPI: 1891364774
Provider Name (Legal Business Name): BETTINA RENEE BELLAMY NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4318
US

IV. Provider business mailing address

1650 GALISTEO ST
SANTA FE NM
87505-4747
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-6200
  • Fax:
Mailing address:
  • Phone: 206-823-1004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29682
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number66319
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: