Healthcare Provider Details

I. General information

NPI: 1396198628
Provider Name (Legal Business Name): TIMOTHY GEBHART DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1691 GALISTEO ST STE C
SANTA FE NM
87505-4781
US

IV. Provider business mailing address

1691 GALISTEO ST STE C
SANTA FE NM
87505-4781
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-5631
  • Fax: 866-434-6657
Mailing address:
  • Phone: 505-983-5631
  • Fax: 866-434-6657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number86292
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: