Provider Demographics
NPI:1760489926
Name:ADDINGTON, ROY (PMHNP DNP)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:
Last Name:ADDINGTON
Suffix:
Gender:M
Credentials:PMHNP DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 BECKNER ROAD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507
Mailing Address - Country:US
Mailing Address - Phone:505-443-2968
Mailing Address - Fax:505-992-4990
Practice Address - Street 1:4730 BECKNER ROAD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507
Practice Address - Country:US
Practice Address - Phone:505-443-2968
Practice Address - Fax:505-443-8313
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-02
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM01548363LF0000X
NMCNP-01548363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM17176719Medicaid
CO30925525Medicaid
NMCNP-01548OtherPMHNP
NMRN-72155OtherRN
NMCNP-01548OtherNM CERTIFIED NURSE PRACTITIONER
NMCS00215061OtherNM CONTROLLED SUBSTANCE REGISTRATION
Q1187Medicare UPIN