Sandia Vista Psychiatric-Mental Health

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

SANDIA VISTA PSYCHIATRIC-MENTAL HEALTH

Practice address

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

Phone

(505) 225-3110

Fax

(505) 207-7988

NPI assigned

Aug 29, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Desiree R Provencio, DNP, CNP, PMHNP-BCNPI 1336648328

Title

Member/Manager

Phone

(505) 225-3110

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

Practitioners 1

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

• Desiree Renee Provencio, DNP, CNP, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Albuquerque, NM
  • NPI 1336648328
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1661731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763424000000",
    "number": "1396464723",
    "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": {
        "organization_name": "SANDIA VISTA PSYCHIATRIC-MENTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-29",
        "last_updated": "2025-11-18",
        "certification_date": "2025-11-18",
        "status": "A",
        "authorized_official_last_name": "PROVENCIO",
        "authorized_official_first_name": "DESIREE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MEMBER/MANAGER",
        "authorized_official_telephone_number": "505-225-3110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP, CNP, PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandia Surgical Inc
• Sandia Therapy and Wellness Center
• Sandia Transportation
• Sandia View Fountain Hill LLC
• Sandia View Spain
• Sandia Wheelchair Solutions
• Kathleen Sandidge
• Nancy L Sandmann, D.D.S.
• Maria Sandoval-Cisneros
• Payton Sandoval-Eddy, MD

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.