Healthcare Provider Details

I. General information

NPI: 1558947770
Provider Name (Legal Business Name): GRACE-ANNE STIMPSON ARNP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 11/20/2021
Certification Date: 11/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 AMERICAS PKWY NE STE 200
ALBUQUERQUE NM
87110-8172
US

IV. Provider business mailing address

6565 AMERICAS PKWY NE STE 200
ALBUQUERQUE NM
87110-8172
US

V. Phone/Fax

Practice location:
  • Phone: 505-932-6413
  • Fax:
Mailing address:
  • Phone: 505-932-6413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GRACE-ANNE STIMPSON
Title or Position: OWNER
Credential: NP
Phone: 505-932-6413