Provider Demographics
NPI:1033437876
Name:JACCARD, DEBRA JOY (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:JOY
Last Name:JACCARD
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:JOY
Other - Last Name:JACCARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:806 PASEO DE LAS GOLONDRINAS
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-5560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2300 GRANDE BLVD SE STE A
Practice Address - Street 2:PMS DBA PMS FAMILY HEALTH CENTER
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1755
Practice Address - Country:US
Practice Address - Phone:505-962-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR51599163WP0809X
NMCNP-01762363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult