Lifted Clinical Practice, PLLC

Primary specialty

Community Health Clinic/CenterTaxonomy code 261QC1500X

License

688447 Issued in TX

Legal business name

LIFTED CLINICAL PRACTICE, PLLC

Practice address

2801 Rodeo Rd Ste C14
Santa Fe, NM 87507-6503

Phone

(505) 430-0760

Fax

(866) 354-3833

NPI assigned

Jan 24, 2017

Last updated

Sep 8, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Funmilayo Aina, DNP,FNP-C

Title

Family Nurse Practitioner

Phone

(505) 430-0760

Specialties & licenses 2

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1485216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662595200000",
    "number": "1447797758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 RODEO RD STE C14",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875076503",
            "telephone_number": "505-430-0760",
            "fax_number": "866-354-3833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 RODEO RD STE C14",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875076503",
            "telephone_number": "505-430-0760",
            "fax_number": "866-354-3833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFTED CLINICAL PRACTICE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-24",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A",
        "authorized_official_last_name": "AINA",
        "authorized_official_first_name": "FUNMILAYO",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER",
        "authorized_official_telephone_number": "505-430-0760",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP,FNP-C"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "TX",
            "license": "AP123182",
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "TX",
            "license": "688447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.