Provider Demographics
NPI:1831954841
Name:BARELA, JENNIFER A (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:BARELA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 SOUTHERN BLVD SE STE 105
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-5859
Mailing Address - Country:US
Mailing Address - Phone:505-270-0840
Mailing Address - Fax:
Practice Address - Street 1:3301 SOUTHERN BLVD SE STE 105
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-5859
Practice Address - Country:US
Practice Address - Phone:505-270-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM77335363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner