=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629952288
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY CODDINGTON RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2025
-----------------------------------------------------
Last Update Date | 08/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 E MISSOURI AVE
-----------------------------------------------------
City | MELROSE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88124-9533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-253-4269
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2620 NORTHGLEN DR
-----------------------------------------------------
City | CLOVIS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88101-2935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-910-6643
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WS0200X
-----------------------------------------------------
Taxonomy Name | School Registered Nurse
-----------------------------------------------------
License Number | RN-80955
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------