MEDICARE: DR. AMBER MARIE BAHM NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LC1500X	Community Health Nurse Practitioner	AP11392	AZ
2	363LF0000X	Family Nurse Practitioner	AP11392	AZ

General Provider Information

NPI Number	:	1619460532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMBER MARIE BAHM NP

Provider Business Mailing Address
First Line	:	1090 COMMERCE DR
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-3700
Country	:	US
Telephone Number	:	928-583-1000
Fax Number	:	866-323-8458

Provider Business Practice Location Address
First Line	:	51 S BRIAN MICKELSEN PKWY
Second Line	:
City	:	COTTONWOOD
State	:	AZ
Zip	:	86326-3610
Country	:	US
Telephone Number	:	928-639-8132
Fax Number	:	866-274-8919

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2018
Last Update Date	:	03/18/2026

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