Provider Demographics
NPI:1891545935
Name:NEW MEXICO ADHD, LLC
Entity Type:Organization
Organization Name:NEW MEXICO ADHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ARNP
Authorized Official - Prefix:
Authorized Official - First Name:AVERY
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-750-4001
Mailing Address - Street 1:2582 CAMINO PLATA LOOP NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-5825
Mailing Address - Country:US
Mailing Address - Phone:505-750-4001
Mailing Address - Fax:505-230-4201
Practice Address - Street 1:2582 CAMINO PLATA LOOP NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-5825
Practice Address - Country:US
Practice Address - Phone:505-750-4001
Practice Address - Fax:505-230-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty