Healthcare Provider Details

I. General information

NPI: 1003287301
Provider Name (Legal Business Name): NATHANIEL GERARDO CERVANTES FNP-C, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 COMMONS AVE NE STE A
ALBUQUERQUE NM
87109-5831
US

IV. Provider business mailing address

6806 SABINAL
SAN ANTONIO TX
78252-4450
US

V. Phone/Fax

Practice location:
  • Phone: 505-585-5580
  • Fax: 505-585-5583
Mailing address:
  • Phone: 956-371-2007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number65326
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP129275
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: