Basic Information
| Provider Information | |||||||||
| NPI: | 1588868921 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ACKERLEY | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | ELLEN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1320 S. SOLANO | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 88001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755277900 | ||||||||
| FaxNumber: | 5755714872 | ||||||||
| Practice Location | |||||||||
| Address1: | 1210 E. PENNSYLVANIA | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205735417 | ||||||||
| FaxNumber: | 5207412191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 07/31/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | RN030428 | AZ | N | Behavioral Health & Social Service Providers | Counselor | 363L00000X | RN030428 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP0808X | CNP-02382 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.