Healthcare Provider Details

I. General information

NPI: 1033437876
Provider Name (Legal Business Name): DEBRA JOY JACCARD PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBRA JOY JACCARD PMHNP-BC

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4477 IRVING BLVD NW STE B
ALBUQUERQUE NM
87114-5529
US

IV. Provider business mailing address

806 PASEO DE LAS GOLONDRINAS
BERNALILLO NM
87004-5560
US

V. Phone/Fax

Practice location:
  • Phone: 505-228-2853
  • Fax: 505-998-7343
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP-01762
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNO-01762
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR51599
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: