Provider Demographics
NPI:1033999859
Name:PAVON TERRERO, MERCY ALEJANDRA (PMHNP)
Entity Type:Individual
Prefix:
First Name:MERCY
Middle Name:ALEJANDRA
Last Name:PAVON TERRERO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:MERCY
Other - Middle Name:A
Other - Last Name:PAVON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP
Mailing Address - Street 1:12701 SANDIA RIDGE PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-8173
Mailing Address - Country:US
Mailing Address - Phone:347-639-3712
Mailing Address - Fax:
Practice Address - Street 1:8226 MENAUL BLVD NE STE 610
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4614
Practice Address - Country:US
Practice Address - Phone:206-550-6164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM59084364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health