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General NPI Number Information
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NPI Number | 1689478505
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Entity Type | Organization
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Legal Business Name | MIND AND BODY MEDICAL AND RECOVERY
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 2900 LOUISIANA BLVD NE STE A2
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-3550
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Country | US
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Telephone | 505-999-0470
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 LOUISIANA BLVD NE STE A2
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-3550
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Country | US
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Telephone | 505-999-0470
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC MENTAL HEALTH NP
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Name | NICOLE MESTAS
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Credential | PMHNP-BC
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Telephone | 505-999-0470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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