MEDICARE: JEANNA ANN FORD APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SA2200X	Adult Health Clinical Nurse Specialist	82623	OK
2	364SA2200X	Adult Health Clinical Nurse Specialist	CNS-00261	NM

General Provider Information

NPI Number	:	1619383395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNA ANN FORD APRN

Provider Business Mailing Address
First Line	:	6608 SALT CEDAR TRL NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-2384
Country	:	US
Telephone Number	:	505-585-1865
Fax Number	:

Provider Business Practice Location Address
First Line	:	1823 CAMINO DE SALUD
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-3782
Country	:	US
Telephone Number	:	505-688-6921
Fax Number	:	505-925-4594

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2014
Last Update Date	:	01/08/2025

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