Provider Demographics
NPI:1861974024
Name:GUILLEN, FERNANDO JAVIER SR (PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:JAVIER
Last Name:GUILLEN
Suffix:SR
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
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Mailing Address - Street 1:385 CALLE DE ALEGRA STE A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3423
Mailing Address - Country:US
Mailing Address - Phone:575-526-1105
Mailing Address - Fax:575-524-4266
Practice Address - Street 1:826 ANTHONY DR.
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021
Practice Address - Country:US
Practice Address - Phone:575-201-5135
Practice Address - Fax:575-449-4052
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM75069163WP0808X
NM53565363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM55025340Medicaid