Healthcare Provider Details

I. General information

NPI: 1386589083
Provider Name (Legal Business Name): MEDIX CLINICAL PSYCHIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 4TH STREET NW SUITE 102-3110
ALBUQUERQUE NM
87102
US

IV. Provider business mailing address

500 4TH ST NW STE 102-3110
ALBUQUERQUE NM
87102-5324
US

V. Phone/Fax

Practice location:
  • Phone: 214-577-2381
  • Fax:
Mailing address:
  • Phone: 214-577-2381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DOROTHY NJIDEKA NWANNE
Title or Position: DIRECTOR
Credential: NP
Phone: 214-577-2381