Healthcare Provider Details

I. General information

NPI: 1154730844
Provider Name (Legal Business Name): MARY-BETH COTY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 11/01/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF NEW MEXICO HOSPITAL 2211 LOMAS BLVD, NE
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

933 BRADBURY DRIVE, SE SUITE 2222
ALBUQUERQUE NM
87106-4374
US

V. Phone/Fax

Practice location:
  • Phone: 502-589-8915
  • Fax: 502-499-1259
Mailing address:
  • Phone: 502-589-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3008751
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number62822
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: