Edwin Akwanga
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Gallup, NM
NPI 1659061323 · NPPES record last updated Jun 10, 2024
Key facts
- NPI
- 1659061323
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 73651 (NM)
- Practice address
- 1500 S Second St Ste B
Gallup, NM 87301-5898 - Phone
- (505) 420-5111
- Fax
- (505) 420-5114
- NPI assigned
- May 8, 2023
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
213 W Mesa Ave
Gallup, NM 87301-6335
Phone (325) 260-6726
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 |
|---|---|---|---|---|
| I20230807000033 | NM | Practitioner - Nurse Practitioner | 8325409410 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1117773 | TX | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Compassionate Health LLC | Psychiatric/Mental Health | Current |
Accepting new patients |
Locations
213 W Mesa Ave
Gallup, NM 87301
Phone (325) 260-6726
1500 S Second St
Ste B
Gallup, NM 87301
Phone (505) 420-5111
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 1117773 | TX | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 73651 | NM | Yes |
Addresses
Primary practice location
1500 S Second St Ste B
Gallup, NM 87301-5898
Mailing address
1500 S Second St Ste B
Gallup, NM 87301-5898
Phone (505) 420-5111
Other providers in Gallup, NM
- Carmelita Agodon
- Calandra Ahasteen
- Jamesita Lynn Ahasteen
- Don Ahrens
- Yvonne Ahumada
- Relindis Mana Akwanga
- Hadith Alatorre
- Margot Albert
- Matilda Albidrez
- Albuquerque
All providers in Gallup, 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 Jun 10, 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.