Healthcare Provider Details

I. General information

NPI: 1437933470
Provider Name (Legal Business Name): ALLYSSA TEDDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 LA MIRADA PL NE STE 700
ALBUQUERQUE NM
87109-1620
US

IV. Provider business mailing address

1801 BLACK GOLD ST SE
ALBUQUERQUE NM
87123-2190
US

V. Phone/Fax

Practice location:
  • Phone: 505-920-0087
  • Fax:
Mailing address:
  • Phone: 505-920-0087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number79965
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: