Healthcare Provider Details

I. General information

NPI: 1558051425
Provider Name (Legal Business Name): BERNICE BECERRA MSN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 BRELAND DR
LAS CRUCES NM
88003
US

IV. Provider business mailing address

PO BOX 24058
EL PASO TX
79914-0058
US

V. Phone/Fax

Practice location:
  • Phone: 575-646-8306
  • Fax:
Mailing address:
  • Phone: 915-487-1604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number73382
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: