Amy Joyce Gilbreath, RN

Individual provider Active NPI School Registered Nurse · Grady, NM

NPI 1043866940 · NPPES record last updated Aug 15, 2019

Key facts

NPI
1043866940
Entity type
Individual (NPI type 1)
Primary specialty
School Registered Nurse 163WS0200X
License
57171 (NM)
Practice address
100 Franklin St.
Grady, NM 88120
Phone
(575) 576-2466
Fax
(575) 576-2772
NPI assigned
Aug 15, 2019
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
57171NMMDSchool Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
San Jon School Based Health Center Past
since Aug 18, 2019
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
School Registered Nurse
Group: 193400000X SINGLE SPECIALTY GROUP
163WS0200X 57171 NM Yes

Addresses

Primary practice location

100 Franklin St.
Grady, NM 88120

Mailing address

PO Box 5
San Jon, NM 88434-0005
Phone (575) 576-2466

Other providers in Grady, NM

All providers in Grady, NM · School Registered Nurse in New Mexico

Sources for this page

Verify at the official NPI Registry.