Healthcare Provider Details

I. General information

NPI: 1619383395
Provider Name (Legal Business Name): JEANNA ANN FORD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 CAMINO DE SALUD
ALBUQUERQUE NM
87106-3782
US

IV. Provider business mailing address

6608 SALT CEDAR TRL NW
ALBUQUERQUE NM
87120-2384
US

V. Phone/Fax

Practice location:
  • Phone: 505-688-6921
  • Fax: 505-925-4594
Mailing address:
  • Phone: 505-585-1865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number82623
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberCNS-00261
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: