Healthcare Provider Details

I. General information

NPI: 1629952288
Provider Name (Legal Business Name): AMY CODDINGTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E MISSOURI AVE
MELROSE NM
88124-9533
US

IV. Provider business mailing address

2620 NORTHGLEN DR
CLOVIS NM
88101-2935
US

V. Phone/Fax

Practice location:
  • Phone: 575-253-4269
  • Fax:
Mailing address:
  • Phone: 801-910-6643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN-80955
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: