Healthcare Provider Details

I. General information

NPI: 1013529353
Provider Name (Legal Business Name): CAROLYN AMES DNP, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25111 N 21ST AVE UNIT 147
PHOENIX AZ
85085-0060
US

IV. Provider business mailing address

25111 N 21ST AVE UNIT 147
PHOENIX AZ
85085-0060
US

V. Phone/Fax

Practice location:
  • Phone: 507-272-9510
  • Fax:
Mailing address:
  • Phone: 507-272-9510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number292519
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number292519
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN180006
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: