Active NPI
Priscilla Phan, PSYD
- Clinical Psychologist
- Cannon Afb, NM
National Provider Identifier
1699412171
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0810008963
- Practice address
- 224 W D.L. Ingram Ave
BLDG. 1408
Cannon Afb, NM 88103 - Phone
- (575) 784-1108
- NPI assigned
- May 17, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | NM | ||
| Student in an Organized Health Care Education/Training Program | 390200000X | TX | ||
| Clinical Psychologist | 103TC0700X | 0810008963 | VA | Primary |
Addresses
Primary practice location
224 W D.L. Ingram Ave
BLDG. 1408
Cannon Afb, NM 88103
Mailing address
27 Somdg
104 W. D.L. Ingram Ave
Cannon Afb, NM 88101
Phone (575) 784-1108
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810008963 | VA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750982400000",
"number": "1699412171",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "27 SOMDG",
"address_2": "104 W. D.L. INGRAM AVE",
"city": "CANNON AFB",
"state": "NM",
"postal_code": "88101",
"telephone_number": "575-784-1108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "224 W D.L. INGRAM AVE",
"address_2": "BLDG. 1408",
"city": "CANNON AFB",
"state": "NM",
"postal_code": "88103",
"telephone_number": "575-784-1108"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "PRISCILLA",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-17",
"last_updated": "2025-06-27",
"certification_date": "2025-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NM",
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "TX",
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810008963",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cannon Afb, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.