Kenneth Bradley Chipman, CNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Farmington, NM
NPI 1497593693 · NPPES record last updated Jul 20, 2024
Key facts
- NPI
- 1497593693
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 80060 (NM)
- Practice address
- 4801 N Butler Ave
Farmington, NM 87401-6002 - Phone
- (505) 327-0002
- NPI assigned
- Jul 20, 2024
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- San Juan Health and Wellness Center
Practice addresses (Care Compare)
4801 N Butler Ave
Suite 1101
Farmington, NM 87401-1013
Phone (505) 327-0002
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240823000020 | NM | Practitioner - Nurse Practitioner | 9335688241 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Merced-LLC Merced Counseling Services | Current |
Accepting new patients | |
| San Juan Health and Wellness Center | Psychiatric/Mental Health | Current |
Accepting new patients |
Locations
4801 N Butler Ave
Ste 1101
Farmington, NM 87401
Phone (505) 327-0002
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 80060 | NM | Yes |
Addresses
Primary practice location
4801 N Butler Ave
Farmington, NM 87401-6002
Mailing address
3500 Alta Vista Dr
Farmington, NM 87402-8810
Phone (505) 573-2723
Other providers in Farmington, NM
- Rachael Cheney
- Chevannes Clinic Solutions, LLC
- Child & Family Wellness
- Child Psychology Center
- Childhaven, Inc
- Choices Behavioral Health Services, Inc.
- Julie Kristine Chota
- Frank Charles Chovan
- Barbara Maurer Christensen
- Joshua Mark Christensen
All providers in Farmington, NM · Psychiatric/Mental Health Nurse Practitioner 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 Jul 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.