Healthcare Provider Details

I. General information

NPI: 1356259022
Provider Name (Legal Business Name): BLAKE POUND PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

135 MADISON ST NE
ALBUQUERQUE NM
87108-1238
US

IV. Provider business mailing address

413 RICHMOND DR SE
ALBUQUERQUE NM
87106-2241
US

V. Phone/Fax

Practice location:
  • Phone: 505-365-4775
  • Fax:
Mailing address:
  • Phone: 505-365-4775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number91600
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: