Healthcare Provider Details

I. General information

NPI: 1972661148
Provider Name (Legal Business Name): JEANNE M CORNS CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANNE CORNS RN, PMHCNS, PMHNP

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2557
  • Fax:
Mailing address:
  • Phone: 505-272-2557
  • Fax: 505-272-0680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP01076
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209027218
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberCNS00178
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN11006593
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: