Individual provider Active NPI

Gloria Adriana Rodriguez, FNP, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Las Cruces, NM
National Provider Identifier
1811460579
Registry record updated Jul 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
79582 Issued in NM
Practice address
1100 S Main St Ste 113
Las Cruces, NM 88005-2921
Phone
(575) 294-5724
Fax
(575) 259-5088
NPI assigned
Jan 5, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X AP139887 TX
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 79582 NM Primary

Addresses

Primary practice location

1100 S Main St Ste 113
Las Cruces, NM 88005-2921

Mailing address

9895 Alameda Ave
Socorro, TX 79927-2956

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250908003225 TX Practitioner - Nurse Practitioner 6507368545 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

5860 N Mesa St
Suite 111
El Paso, TX 79912-4666

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
79582NMMDPsychiatric/Mental Health Nurse Practitioner
AP139887TXMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Amare Wellness Center, PLLC CurrentSince Jan 1, 2025 Accepting new patients

Locations

5860 N Mesa St
Ste 111
El Paso, TX 79912
Phone (915) 222-1348

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1546646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721692800000",
    "number": "1811460579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9895 ALAMEDA AVE",
            "city": "SOCORRO",
            "state": "TX",
            "postal_code": "799272956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 S MAIN ST STE 113",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880052921",
            "telephone_number": "575-294-5724",
            "fax_number": "575-259-5088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "GLORIA",
        "middle_name": "ADRIANA",
        "credential": "FNP, PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-05",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TX",
            "license": "AP139887",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NM",
            "license": "79582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Cruces, NM

Sources for this page

Verify at the official NPI Registry.