Healthcare Provider Details

I. General information

NPI: 1669790010
Provider Name (Legal Business Name): DEBORAH KELLY MSN, RN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W GRIGGS AVE
LAS CRUCES NM
88001-1234
US

IV. Provider business mailing address

385 CALLE DE ALEGRA STE A
LAS CRUCES NM
88005-3423
US

V. Phone/Fax

Practice location:
  • Phone: 575-647-2800
  • Fax: 575-647-2898
Mailing address:
  • Phone: 575-526-1105
  • Fax: 575-524-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP-01627
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: