Desert Skies Family Practice Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

R21461 Issued in NM

Legal business name

DESERT SKIES FAMILY PRACTICE INC.

Practice address

1101 9TH St Ste B
Alamogordo, NM 88310-6432

Phone

(575) 437-1113

Fax

(575) 437-1777

NPI assigned

Oct 24, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ilana Cornelius, CNP

Title

Family Nurse Practitioner

Phone

(575) 437-1113

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1319414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332720000000",
    "number": "1003192956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 9TH ST STE B",
            "city": "ALAMOGORDO",
            "state": "NM",
            "postal_code": "883106432",
            "telephone_number": "575-437-1113",
            "fax_number": "575-437-1777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 9TH ST STE B",
            "city": "ALAMOGORDO",
            "state": "NM",
            "postal_code": "883106432",
            "telephone_number": "575-437-1113",
            "fax_number": "575-437-1777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT SKIES FAMILY PRACTICE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-24",
        "last_updated": "2012-03-26",
        "status": "A",
        "authorized_official_last_name": "CORNELIUS",
        "authorized_official_first_name": "ILANA",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER",
        "authorized_official_telephone_number": "575-437-1113",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NM",
            "license": "R21461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE I",
            "identifier": "1427011881",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89009851",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE # I RECEIVED",
            "identifier": "NM AAA2448",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carolyn Derden
• Michele Elizabeth Derouen, BSPTA
• Jennifer Deroy, CNP
• Kayla Derrick, CSFA
• Desert Sands Mental Health LLC
• Desert Willow Behavioral Health, LLC
• Swathi Devaki, DDS
• Noel G Dias, MD
• Vanessa Alicia Diaz
• Jonah Allen Dinsdale, LPCC

• Clinic/Center in Alamogordo, NM
• Providers in Alamogordo, NM by specialty
• Clinic/Center in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.