Small Town Family Practice LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SMALL TOWN FAMILY PRACTICE LLC

Practice address

4225 Montgomery Blvd NE
Albuquerque, NM 87109-1103

Phone

(505) 366-3635

Fax

(505) 221-5429

NPI assigned

Sep 30, 2021

Organization subpart

No

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

Authorized official

Name

Deanna Rene Clark, NURSE PRACTITIONERNPI 1477003366

Title

Co-Owner/ Co-Manager

Phone

(505) 366-3635

Specialties & licenses 5

Addresses

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Deanna R Clark, CFNP

  • Family Nurse Practitioner
  • Albuquerque, NM
  • NPI 1477003366
  NPD Authorized official

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

{
    "created_epoch": "1632960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632960000000",
    "number": "1164194940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4225 MONTGOMERY BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871091103",
            "telephone_number": "505-366-3635",
            "fax_number": "505-221-5429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4225 MONTGOMERY BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871091103",
            "telephone_number": "505-366-3635",
            "fax_number": "505-221-5429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMALL TOWN FAMILY PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-30",
        "last_updated": "2021-09-30",
        "certification_date": "2021-09-30",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "DEANNA",
        "authorized_official_middle_name": "RENE",
        "authorized_official_title_or_position": "CO-OWNER/ CO-MANAGER",
        "authorized_official_telephone_number": "505-366-3635",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "deannaclark@direct.practicefusion.com",
            "affiliation": "N",
            "address_1": "4225 Montgomery Blvd NE",
            "city": "Albuquerque",
            "state": "NM",
            "country_code": "US",
            "postal_code": "871091103",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jill A Slominski, MD
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• Elizabeth Danielle Sluder, OTR
• Small Steps Child Counseling, LLC
• Small Steps International
• Alicia Victoria Small, CNP
• Brigid Small, M.S., BCBA
• Candice Marion Small
• Christyn Marie Small, LPCC
• Maureen D Small, MD

• Primary Care Clinic/Center in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Primary Care Clinic/Center in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2021; 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.