Healthcare Provider Details

I. General information

NPI: 1801253083
Provider Name (Legal Business Name): MBE SYLVESTER TAYOURH PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3112 ANDERSON RD NE
RIO RANCHO NM
87144-1483
US

IV. Provider business mailing address

3112 ANDERSON RD NE
RIO RANCHO NM
87144-1483
US

V. Phone/Fax

Practice location:
  • Phone: 202-706-0905
  • Fax: 505-581-8035
Mailing address:
  • Phone: 202-706-0905
  • Fax: 505-581-8035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0813X
TaxonomyGeropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
License Number1114373
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1114373
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0106502
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number75598
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number867533
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: