Healthcare Provider Details

I. General information

NPI: 1396999272
Provider Name (Legal Business Name): KEIRA STEVENS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 RIVERSIDE PLAZA LN NW STE 100
ALBUQUERQUE NM
87120-1908
US

IV. Provider business mailing address

6300 RIVERSIDE PLAZA LN NW STE 100
ALBUQUERQUE NM
87120-1908
US

V. Phone/Fax

Practice location:
  • Phone: 505-456-0400
  • Fax: 833-913-2523
Mailing address:
  • Phone: 505-456-0400
  • Fax: 833-913-2523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number55258
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3183
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: