Healthcare Provider Details

I. General information

NPI: 1821822123
Provider Name (Legal Business Name): AMY LAWRENCE SIMONDS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S DIAMOND AVE
DEMING NM
88030-3752
US

IV. Provider business mailing address

300 S DIAMOND AVE
DEMING NM
88030-3752
US

V. Phone/Fax

Practice location:
  • Phone: 755-464-6635
  • Fax: 505-443-8331
Mailing address:
  • Phone: 755-464-6635
  • Fax: 505-443-8331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704288331
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number83911
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: