Healthcare Provider Details

I. General information

NPI: 1831793710
Provider Name (Legal Business Name): EMMANUEL KPWE NJI PMHNP-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 SAN PEDRO DR NE STE 205F
ALBUQUERQUE NM
87110-6749
US

IV. Provider business mailing address

1330 SAN PEDRO DR NE STE 205F
ALBUQUERQUE NM
87110-6749
US

V. Phone/Fax

Practice location:
  • Phone: 903-957-0082
  • Fax: 903-957-0351
Mailing address:
  • Phone: 903-957-0082
  • Fax: 903-957-0351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1020704
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number62092
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: