Healthcare Provider Details

I. General information

NPI: 1700332103
Provider Name (Legal Business Name): GRACE-ANNE STIMPSON MSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
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: 505-932-7610
  • Fax:
Mailing address:
  • Phone: 505-932-6413
  • Fax: 715-227-2868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024179525
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1000542
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5008837
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95015744
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9344110
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberC-APN.0101386-C-NP
License Number StateCO
# 7
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number60360
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: