Healthcare Provider Details

I. General information

NPI: 1598065484
Provider Name (Legal Business Name): AMBER J STOLL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N ROADRUNNER PKWY STE 228
LAS CRUCES NM
88011-2001
US

IV. Provider business mailing address

7300 RANCH ROAD 2222, BLDG 1, STE 200
AUSTIN TX
78730-3255
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-1177
  • Fax:
Mailing address:
  • Phone: 512-759-8932
  • Fax: 512-233-2711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2010-0039
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: