Provider Demographics
NPI:1154730844
Name:COTY, MARY-BETH (APRN)
Entity type:Individual
Prefix:
First Name:MARY-BETH
Middle Name:
Last Name:COTY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 BRADBURY DRIVE, SE SUITE 2222
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:502-589-8600
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF NEW MEXICO HOSPITAL
Practice Address - Street 2:2211 LOMAS BLVD, NE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:502-589-8915
Practice Address - Fax:502-499-1259
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008751363LP0808X
NM62822363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100306330Medicaid
IN300010397Medicaid
KYK155701OtherMEDICARE