Healthcare Provider Details

I. General information

NPI: 1891545935
Provider Name (Legal Business Name): NEW MEXICO ADHD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2582 CAMINO PLATA LOOP NE
RIO RANCHO NM
87144-5825
US

IV. Provider business mailing address

2582 CAMINO PLATA LOOP NE
RIO RANCHO NM
87144-5825
US

V. Phone/Fax

Practice location:
  • Phone: 505-750-4001
  • Fax: 505-230-4201
Mailing address:
  • Phone: 505-750-4001
  • Fax: 505-230-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AVERY KENNEDY
Title or Position: OWNER, ARNP
Credential:
Phone: 505-750-4001