Healthcare Provider Details

I. General information

NPI: 1558891184
Provider Name (Legal Business Name): POE PSYCHIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 N SCHWARTZ AVE
FARMINGTON NM
87401
US

IV. Provider business mailing address

234 N SCHWARTZ AVE
FARMINGTON NM
87401-5547
US

V. Phone/Fax

Practice location:
  • Phone: 505-427-0401
  • Fax: 505-787-2174
Mailing address:
  • Phone: 505-427-0401
  • Fax: 505-787-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP-02352
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: CATHY B POE
Title or Position: CEO / OWNER
Credential:
Phone: 505-427-0401