Kelly M Young, RN, CNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Farmington, NM
NPI 1245679000 · NPPES record last updated Jun 20, 2023
Key facts
- NPI
- 1245679000
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- CNP-02180 (NM)
- Practice address
- 1009 Ridgeway PL
Farmington, NM 87401-2092 - Phone
- (505) 327-0002
- Fax
- (505) 325-9443
- NPI assigned
- Jun 14, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mora Valley Community Health Services Inc
San Juan Health and Wellness Center
Practice addresses (Care Compare)
3 Mora Valley Clinic Rd
Mora, NM 87732-2202
Phone (575) 387-5069
4801 N Butler Ave
Suite 1101
Farmington, NM 87401-1013
Phone (505) 327-0002
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131025001608 | NM | Practitioner - Nurse Practitioner | 8123253234 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN-77457 | NM | MD | Registered Nurse |
| CNP-02180 | NM | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| San Juan Health and Wellness Center | Family | Current |
Accepting new patients |
| Mora Valley Community Health Services Inc | Past | Accepting new patients |
Locations
4801 N Butler Ave
Ste 1101
Farmington, NM 87401
Phone (505) 327-0002
1009 Ridgeway Pl
Farmington, NM 87401
Phone (505) 327-0002
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN-77457 | NM | |
| Nurse Practitioner | 363L00000X | CNP-02180 | NM | |
| Family Nurse Practitioner | 363LF0000X | CNP-02180 | NM | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | CNP-02180 | NM | Yes |
Addresses
Primary practice location
1009 Ridgeway PL
Farmington, NM 87401-2092
Mailing address
1009 Ridgeway PL
Farmington, NM 87401-2092
Other providers in Farmington, NM
- Shundiina Yazzie
- Melania Yeats
- Greg Evan Yellowman
- Deborah Ann Yost
- Guy Mearle Youell Jr.
- Robert S Young Jr.
- Shawna Young
- William Young
- William Young
- Holly Youvella
All providers in Farmington, NM · Psychiatric/Mental Health Nurse Practitioner in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.