Mary Teresa Omeddo, RN

Primary specialty

Community Health Registered NurseTaxonomy code 163WC1500X

License

65654 Issued in NM

Practice address

85 West Hwy 22
Santo Domingo, NM 87052

Phone

(505) 465-3060

NPI assigned

Dec 21, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Teresa Omeddo Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: teresa.omeddo.p1@direct.kp-hc.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kewa Pueblo Health Corporation

  • Community/Behavioral Health Agency
  • Santo Domingo Pueblo, NM
  • NPI 1336659077
  NPD (past)
• Kewa Pueblo Health Corporation

  • Federally Qualified Health Center (FQHC)
  • Santo Domingo Pueblo, NM
  • NPI 1467739888
  NPD (past)

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

{
    "created_epoch": "1640044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679443200000",
    "number": "1306506019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 340",
            "city": "SANTO DOMINGO PUEBLO",
            "state": "NM",
            "postal_code": "870520340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 WEST HWY 22",
            "city": "SANTO DOMINGO",
            "state": "NM",
            "postal_code": "87052",
            "telephone_number": "505-465-3060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMEDDO",
        "first_name": "MARY",
        "middle_name": "TERESA",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-21",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "TX",
            "license": "889413",
            "primary": false
        },
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "NM",
            "license": "65654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TERESA",
            "last_name": "OMEDDO",
            "credential": "RN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Kewa Pueblo Health Corporation
• Kewa Pueblo Health Corporation
• Kewa Pueblo Health Corporation
• Kewa Pueblo Health Corporation
• Roger L Leonard, RN
• Tai Marie Paquin, LADAC
• John M Robertson, MD
• Samantha Nicole Torres, PHARM D.

• Community Health Registered Nurse in Santo Domingo, NM
• Providers in Santo Domingo, NM by specialty
• Community Health Registered Nurse in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2023; 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.