Bobby N Holstead, PH.D.
Individual provider Active NPI Psychologist · Kirtland Afb, NM
NPI 1487735965 · NPPES record last updated Apr 2, 2021
Key facts
- NPI
- 1487735965
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 214 (NM)
- Practice address
- 2050A 2ND St SE
Kirtland Afb, NM 87117-5103 - Phone
- (505) 846-3200
- Fax
- (575) 784-6028
- NPI assigned
- Oct 18, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 214 | NM | MD | Pediatric Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 214 | NM | Yes |
| Clinical Psychologist | 103TC0700X | 214 | NM |
Addresses
Primary practice location
2050A 2ND St SE
Kirtland Afb, NM 87117-5103
Mailing address
855 Fairway Rd NW
Albuquerque, NM 87107-5720
Phone (505) 379-0734
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00NM00N890 | Other | NM | BC/BS OF NM |
| N6176 | Medicaid | NM | |
| 201004465 | Other | NM | PRESBYTERIAN HEALTH PLAN |
Other providers in Kirtland Afb, NM
- Brett Mason Harrell
- Derek Buryl Hemerick
- Fernando Hernandez Moran
- Joseph Gerard Hogan
- Daniel J Hohman
- James S. Ice
- Christina Jap
- Jarom Jardine
- Jeffery Clifford Jarvis
- Stephen Antonioli Jennings
All providers in Kirtland Afb, NM · Psychologist 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 Apr 2, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.