Integrated Healthcare

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

CNP-0216 Issued in NM

Legal business name

INTEGRATED HEALTHCARE

Practice address

4101 Barbara Loop SE Ste C
Rio Rancho, NM 87124-1011

Phone

(505) 994-4503

Fax

(505) 891-1495

NPI assigned

Jun 10, 2017

Organization subpart

No

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

Authorized official

Name

Jacqueline Eva Willis, NPNPI 1073908281

Title

Owner

Phone

(505) 994-4503

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jacqueline Eva Willis, NURSE PRACTITIONER

  • Psychiatric/Mental Health Nurse Practitioner
  • Rio Rancho, NM
  • NPI 1073908281
  NPD Authorized official

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

{
    "created_epoch": "1497052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497052800000",
    "number": "1659800894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 BARBARA LOOP SE STE C",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241011",
            "telephone_number": "505-994-4503",
            "fax_number": "505-891-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 BARBARA LOOP SE STE C",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241011",
            "telephone_number": "505-994-4503",
            "fax_number": "505-891-1495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-10",
        "last_updated": "2017-06-10",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "EVA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-994-4503",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NM",
            "license": "CNP-0216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Rio Rancho, NM
• Providers in Rio Rancho, NM by specialty
• Psychiatric/Mental Health Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.