Healthcare Provider Details

I. General information

NPI: 1679138671
Provider Name (Legal Business Name): PAMELA AMMONS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA FITZGERALD NP

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 HOSPITAL DR
RATON NM
87740-2002
US

IV. Provider business mailing address

117 CAMINO DE VIDA SUITE 300
SANTA ROSA NM
88435
US

V. Phone/Fax

Practice location:
  • Phone: 575-445-3626
  • Fax: 877-559-2708
Mailing address:
  • Phone: 575-472-4311
  • Fax: 575-472-4313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-55628
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: