Healthcare Provider Details

I. General information

NPI: 1063842813
Provider Name (Legal Business Name): AMBER LYNN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 W BETHANY HOME RD SUITE #2
PHOENIX AZ
85015-1997
US

IV. Provider business mailing address

2200 W BETHANY HOME RD SUITE #2
PHOENIX AZ
85015-1997
US

V. Phone/Fax

Practice location:
  • Phone: 602-710-1187
  • Fax: 602-358-8551
Mailing address:
  • Phone: 602-317-2418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP5269
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: