Provider Demographics
NPI:1972661148
Name:CORNS, JEANNE M (CNS)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:CORNS
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-5355
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:5550 WYOMING BLVD NE
Practice Address - Street 2:PMG WYOMING
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-291-5300
Practice Address - Fax:505-291-5303
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR45190103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM21252581Medicaid
NM21252581Medicaid
343427300Medicare PIN