Healthcare Provider Details

I. General information

NPI: 1023491677
Provider Name (Legal Business Name): VERNON ANTHONY OSBORN PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N FIFTH ST
GALLUP NM
87301-5306
US

IV. Provider business mailing address

HC 61 BOX 1028
RAMAH NM
87321-9600
US

V. Phone/Fax

Practice location:
  • Phone: 505-863-3120
  • Fax: 505-443-8344
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP-02704
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02704
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: