Provider Demographics
NPI:1023491677
Name:OSBORN, VERNON ANTHONY (PMHNP)
Entity type:Individual
Prefix:
First Name:VERNON
Middle Name:ANTHONY
Last Name:OSBORN
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 61 BOX 1028
Mailing Address - Street 2:
Mailing Address - City:RAMAH
Mailing Address - State:NM
Mailing Address - Zip Code:87321-9600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2025 E AZTEC AVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4803
Practice Address - Country:US
Practice Address - Phone:505-863-3828
Practice Address - Fax:505-443-8345
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02704363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily