Healthcare Provider Details

I. General information

NPI: 1639061930
Provider Name (Legal Business Name): JORDYN BARELA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2025
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3896 MONTANA VERDE RD
SANTA FE NM
87507-2652
US

IV. Provider business mailing address

3896 MONTANA VERDE RD
SANTA FE NM
87507-2652
US

V. Phone/Fax

Practice location:
  • Phone: 505-819-7465
  • Fax:
Mailing address:
  • Phone: 505-819-7465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number87893
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: