Healthcare Provider Details

I. General information

NPI: 1851167704
Provider Name (Legal Business Name): PATRICK MCDOUGAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DEPUTY DEAN MIERA DR SW
ALBUQUERQUE NM
87151-5960
US

IV. Provider business mailing address

9405 BLACK FARM LN NW
ALBUQUERQUE NM
87114-5960
US

V. Phone/Fax

Practice location:
  • Phone: 505-839-8838
  • Fax:
Mailing address:
  • Phone: 505-350-8422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number76921
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: