Healthcare Provider Details

I. General information

NPI: 1689393993
Provider Name (Legal Business Name): JOHN DOMINICK ROSSI DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 N MAIN ST
CLOVIS NM
88101-6656
US

IV. Provider business mailing address

605 N MAIN ST
CLOVIS NM
88101-6656
US

V. Phone/Fax

Practice location:
  • Phone: 903-244-8441
  • Fax:
Mailing address:
  • Phone: 903-244-9441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number72205
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: