Healthcare Provider Details

I. General information

NPI: 1255151395
Provider Name (Legal Business Name): AMANDA PRYOR DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3751 DEL REY BLVD
LAS CRUCES NM
88012-7710
US

IV. Provider business mailing address

3595 SPITZ ST
LAS CRUCES NM
88005-1213
US

V. Phone/Fax

Practice location:
  • Phone: 575-382-3500
  • Fax:
Mailing address:
  • Phone: 575-654-0957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number81260
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: