Healthcare Provider Details

I. General information

NPI: 1699380642
Provider Name (Legal Business Name): SARAH HEREDIA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH C HEREDIA APRN, PMHNP-BC

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 BRADBURY DR SE STE 2222
ALBUQUERQUE NM
87106-4375
US

IV. Provider business mailing address

933 BRADBURY DR SE STE 2222
ALBUQUERQUE NM
87106-4375
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-3120
  • Fax: 505-272-8060
Mailing address:
  • Phone: 505-272-3120
  • Fax: 505-272-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number85092
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: