Organization
NOVA CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTAN VALDES NURSE PRACTITIONER (OWNER)
(214) 790-6829
Entity
Organization
Contact information
Practice address
1215 ANTHONY DR STE H, ANTHONY, NM 88021-9379
(575) 517-3885
Mailing address
5203 JUAN TABO BLVD NE STE 2B, ALBUQUERQUE, NM 87111-2691
(214) 790-6829
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902612146
—
TX
Enumeration date
09/01/2025
Last updated
09/01/2025
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