EDALYN KAY JOHNSON (NPI# 1710935200) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710935200 |
| Entity Type | Individual |
| Full Name | EDALYN KAY JOHNSON |
| Credential | CNP |
| Practice Address |
4550 Eubank Blvd Ne Suite 105 Albuquerque NM 87111-3479 |
| Practice Telephone | 5052961120 |
| Practice Fax Number | 5052961121 |
| Mailing Telephone | 5052961120 |
| Mailing Fax Number | 5052961121 |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2008-05-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | R17788 | NM | Nursing Service Providers |
| Y | 363L00000X | Nurse Practitioner | R17788 | NM | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | TRIWEST | 743032990 | 01 |
| Street Address |
4550 EUBANK BLVD NE SUITE 105 |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87111-3479 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821097544 | Mark Leon Schwartz | Chiropractor | 4550 Eubank Blvd Ne, Suite 107, Albuquerque, NM 87111-3479 | 2005-07-14 |
| 1396085239 | Mcr Enterprises, Lp | Naturopath | 4550 Eubank Blvd Ne, Suite 105, Albuquerque, NM 87111-3479 | 2013-02-28 |
| 1194069914 | Sandia Integrative Health LLC | Clinic/Center | 4550 Eubank Blvd Ne, Suite 205, Albuquerque, NM 87111-3479 | 2012-11-16 |
| 1104124080 | W Gregory Rose Dds Pa | Durable Medical Equipment & Medical Supplies | 4550 Eubank Blvd Ne, Suite 201, Albuquerque, NM 87111-2565 | 2011-03-02 |
| 1659606101 | Mcr Enterprises | Acupuncturist | 4550 Eubank Blvd Ne, Suite 105, Albuquerque, NM 87111-3479 | 2009-10-15 |
| 1346408358 | Joseph Hampton Bowers | Dentist | 4550 Eubank Blvd Ne, Suite 207, Albuquerque, NM 87111-3479 | 2008-05-27 |
| 1760657126 | Brenda Mae Macgeorge Burns | Acupuncturist | 4550 Eubank Blvd Ne, Albuquerque, NM 87111-3479 | 2008-04-28 |
| 1467638478 | Mark L. Schwartz, Dc PC | Chiropractor | 4550 Eubank Blvd Ne, Suite 107, Albuquerque, NM 87111-3479 | 2008-01-21 |
| 1295915346 | Natural Womens Health LLC | Clinic/Center | 4550 Eubank Blvd Ne, Ste 105, Albuquerque, NM 87111-3479 | 2007-11-06 |
| 1932278447 | William Gregory Rose | Dentist | 4550 Eubank Blvd Ne, Suite 201, Albuquerque, NM 87111-3479 | 2006-11-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417438110 | Dehlen LLC | Counselor | 11000 Spain Rd Ne, Building E, Albuquerque, NM 87111 | 2018-08-22 |
| 1003313008 | Jessika Junick | Nurse Practitioner | 3825 Eubank Blvd Ne Ste A, Albuquerque, NM 87111 | 2018-04-07 |
| 1881113454 | Hayley Aragon-bell | Day Training/Habilitation Specialist | 3732 Mount Rainier Dr. Ne, Albuquerque, NM 87111 | 2017-09-14 |
| 1750803326 | Sarah Mckenzie Ochoa | Day Training/Habilitation Specialist | 3916 Garcia St Ne, Albuquerque, NM 87111 | 2017-07-14 |
| 1285179549 | Family Dental Health Care | Dentist | 4550 Eubank Blvd, Suite 203, Albuquerque, NM 87111 | 2016-12-22 |
| 1871036202 | Shobha Jagannath | Nurse Practitioner | 10700 Academy Rd Ne Apt 216, Albuquerque, NM 87111 | 2016-12-03 |
| 1508319310 | Mariana Boitano | Licensed Practical Nurse | 5400 Gibson Blvd., Albuquerque, NM 87111 | 2016-07-28 |
| 1184011082 | Adam Halpern | Specialist/Technologist | 4204 Parsifal St, Albuquerque, NM 87111 | 2015-04-20 |
| 1083015770 | Cvs Pharmacy | Public Health or Welfare | 5516 Camino Arbustos Ne, Albuquerque, NM 87111 | 2014-09-12 |
| 1508276973 | Stephanie Gonzales | Physician Assistant | 12241 Academy Rd Ne Ste 204, Albuquerque, NM 87111 | 2014-05-06 |
| Find all providers in zip 87111 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720606882 | Mountain Desert Health LLC | Nurse Practitioner | 2200 Panola St Sw, Albuquerque, NM 87121-2582 | 2020-07-06 |
| 1912538844 | Lorine Derusha | Nurse Practitioner | 625 Silver Ave Sw Fl 2, Albuquerque, NM 87102-3123 | 2020-01-29 |
| 1295374247 | Thomas William Cox | Nurse Practitioner | 12812 Constitution Ave Ne Apt 2, Albuquerque, NM 87112-6142 | 2019-12-21 |
| 1730720632 | Carmen Caterina Marcolina | Nurse Practitioner | 4201 Central Ave Nw # 3, Albuquerque, NM 87105-1630 | 2019-10-01 |
| 1700349834 | Heather Marie Pink | Nurse Practitioner | 7802b Ironwood Ct Se, Albuquerque, NM 87116-1135 | 2019-04-06 |
| 1467936187 | New Mexico Health Care Clinicians LLC | Nurse Practitioner | 3911 4th St Nw Ste A, Albuquerque, NM 87107-2510 | 2018-09-18 |
| 1609354398 | Marisa Escobar | Nurse Practitioner | 3613 State Hwy 528 Nw, Albuquerque, NM 87114-8918 | 2018-08-03 |
| 1154807725 | Andrea Chavez-benavidez | Nurse Practitioner | 6201 Jefferson St Ne Ste 103, Albuquerque, NM 87109-3431 | 2018-07-17 |
| 1356842488 | Jopaul Valles | Nurse Practitioner | 407 Solano Dr Ne, Albuquerque, NM 87108-1045 | 2018-02-23 |
| 1275045700 | Janna Rorebeck | Nurse Practitioner | 6804 Calle Santiago Ne, Albuquerque, NM 87113-1217 | 2017-10-24 |
| Find all providers in ALBUQUERQUE | ||||
| City | ALBUQUERQUE |
| Zip Code | 87111 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.