Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Ethan Blackney-Lopez, AG-ACNP

Individual provider Acute Care Nurse Practitioner · NPI 1619697570

Mr. Ethan Blackney-Lopez, AG-ACNP is a Nurse Practitioner in Albuquerque, New Mexico. Graduated from University of New Mexico School of Medicine in 2022, 4 years ago. Practices with Unm Hospital, a 397-clinician group and accepts Medicare assignment. Licensed in New Mexico.

Years since qualifying
4
Trained at
University of New Mexico School of Medicine
Licensed in
NM
In the registry since
2022
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Practice location Address checks out

2211 Lomas Blvd NE
Albuquerque, NM 87106-2719
Phone: (505) 272-2711
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence 69604 (NM)

Record details

NPI number1619697570
Entity typeIndividual (Type 1)
GenderMale
Credentials AG-ACNP
Sole proprietorNo
NPI enumeratedAugust 31, 2022
Last updated in NPPESMay 26, 2023
Certification dateMay 26, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolUNIVERSITY OF NEW MEXICO SCHOOL OF MEDICINE
Graduated 2022 (4 years in practice)
Group practice Unm Hospital — 397 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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