Healthcare Provider Details

I. General information

NPI: 1831954841
Provider Name (Legal Business Name): JENNIFER A BARELA PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 SOUTHERN BLVD SE STE 105
RIO RANCHO NM
87124-5859
US

IV. Provider business mailing address

3301 SOUTHERN BLVD SE STE 105
RIO RANCHO NM
87124-5859
US

V. Phone/Fax

Practice location:
  • Phone: 505-270-0840
  • Fax:
Mailing address:
  • Phone: 505-270-0840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number77335
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: