Echo Dashawn Favaloro, FNP-C, PMHNP-BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Aztec, NM
NPI 1568288223 · NPPES record last updated Nov 27, 2024
Key facts
- NPI
- 1568288223
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 61910 (NM)
- Practice address
- 6A Road 2930
Aztec, NM 87410-9718 - Phone
- (505) 258-0616
- NPI assigned
- Nov 27, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Taylor G Wright PC
Practice addresses (Care Compare)
406 S Park Ave
Aztec, NM 87410-2226
Phone (505) 334-2852
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 |
|---|---|---|---|---|
| I20250731003952 | NM | Practitioner - Nurse Practitioner | 6002324142 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61910 | NM | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Innovation Medical Group PC | Family | Current |
Accepting new patients |
Locations
406 S Park Ave
Aztec, NM 87410
Phone (505) 334-2852
4740 N Butler Ave
Farmington, NM 87401
Phone (505) 324-6300
6405 S 3000 E
Ste 300
Salt Lake Cty, UT 84121
Phone (801) 266-5113
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 61910 | NM | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 61910 | NM | Yes |
Addresses
Primary practice location
6A Road 2930
Aztec, NM 87410-9718
Mailing address
6A Road 2930
Aztec, NM 87410-9718
Phone (505) 258-0616
Other providers in Aztec, NM
- Megan Lora Dunovan
- Julianna Marie Duran
- James Golden Durfey
- Martin Josue Erives
- Toni Marie Farquharson
- Matthew Vidal Fernandez
- Focused Solutions Counseling, LLC
- Patricia Diane Fordyce-Montanari
- Rebekah Leann French
- Aimee Frenette
All providers in Aztec, 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 Nov 27, 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.