Desiree Renee Provencio, DNP, CNP, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

CNP-03491 Issued in NM

Practice address

9384 Valley View Dr NW Ste 400
Albuquerque, NM 87114-4403

Phone

(505) 225-3110

Fax

(505) 207-7988

NPI assigned

Feb 6, 2018

Last updated

Nov 18, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

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

• Sandia Vista Psychiatric-Mental Health

  • Psychiatric/Mental Health Nurse Practitioner
  • Albuquerque, NM
  • NPI 1396464723
  Medicare reassignment NPD Authorized official
• Presbyterian Medical Services

  dba Rio Rancho Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Rio Rancho, NM
  • NPI 1871505032
  Medicare reassignment NPD
• Presbyterian Medical Services

  dba PMS Central Pharmacy

  • Community/Retail Pharmacy
  • Albuquerque, NM
  • NPI 1306654462
  NPD
• Presbyterian Medical Services

  • Federally Qualified Health Center (FQHC)
  • Santa Fe, NM
  • NPI 1518910553
  NPD

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

{
    "created_epoch": "1517875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763424000000",
    "number": "1336648328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 45450",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871745450",
            "telephone_number": "505-225-3110",
            "fax_number": "505-207-7988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9384 VALLEY VIEW DR NW STE 400",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871144403",
            "telephone_number": "505-225-3110",
            "fax_number": "505-207-7988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENCIO",
        "first_name": "DESIREE",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "DNP, CNP, PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-02-06",
        "last_updated": "2025-11-18",
        "certification_date": "2025-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NM",
            "license": "CNP-03491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prosthetic Orthotic Specialists, Inc (Center for Prosthetic & Orthotic Design)
• Prosthetic Orthotic Specialists, Inc. (Center for Prosthetic & Orthotic Design)
• Proud Moments ABA
• Shawn Proudfoot, LISW
• Joan Prouty, PA-C
• Providence Support Services Inc.
• Provider Cares Network LLC
• Denise Provoost, PTA
• Elizabeth Provost, PT
• PRP Regenerative Pain Institute PC

• Psychiatric/Mental Health Nurse Practitioner in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Psychiatric/Mental Health Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.