Healthcare Provider Details

I. General information

NPI: 1093903320
Provider Name (Legal Business Name): NEXUS HEALTH PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 S PACHECO ST
SANTA FE NM
87505-6103
US

IV. Provider business mailing address

2085 S PACHECO ST
SANTA FE NM
87505-6103
US

V. Phone/Fax

Practice location:
  • Phone: 505-395-3000
  • Fax:
Mailing address:
  • Phone: 505-395-3000
  • Fax: 505-983-7571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY BLANKS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 505-469-5569