Healthcare Provider Details

I. General information

NPI: 1326904160
Provider Name (Legal Business Name): AMANDA RAE CARRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2025
Last Update Date: 12/24/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 E LOHMAN AVE
LAS CRUCES NM
88011-8255
US

IV. Provider business mailing address

24 KC ROAD
ALAMOGORDO NM
88310
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-7600
  • Fax:
Mailing address:
  • Phone: 575-425-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR057362
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: