MEDICARE: DR. ROY ADDINGTON PMHNP DNP

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	363LF0000X	Family Nurse Practitioner	01548	NM
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	CNP-01548	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	CNP-01548	OTHER	NM	PMHNP
4	RN-72155	OTHER	NM	RN
5	CNP-01548	OTHER	NM	NM CERTIFIED NURSE PRACTITIONER

General Provider Information

NPI Number	:	1760489926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROY ADDINGTON PMHNP DNP

Provider Business Mailing Address
First Line	:	4730 BECKNER ROAD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507
Country	:	US
Telephone Number	:	505-443-2968
Fax Number	:	505-992-4990

Provider Business Practice Location Address
First Line	:	4730 BECKNER ROAD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507
Country	:	US
Telephone Number	:	505-443-2968
Fax Number	:	505-443-8313

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

Provider Enumeration Date	:	07/02/2005
Last Update Date	:	11/07/2023

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