Amanda Renee Elam, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

CNP-03488 Issued in NM

Practice address

2301 N MLK Blvd
Clovis, NM 88101-9401

Phone

(575) 762-4455

NPI assigned

Feb 2, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Fedko Emergency Physicians New Mexico LLC

  • Emergency Medicine Physician
  • Grants, NM
  • NPI 1770047441

  NM

  Medicare reassignment NPD
• Clovis Family Health Care Center LLC

  • Family Medicine Physician
  • Clovis, NM
  • NPI 1760123475
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517529600000",
    "number": "1780183954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 N MLK BLVD",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881019401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 N MLK BLVD",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881019401",
            "telephone_number": "575-762-4455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELAM",
        "first_name": "AMANDA",
        "middle_name": "RENEE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-02",
        "last_updated": "2018-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "CNP-03488",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eastern New Mexico Foot & Ankle, PC
• Eastern New Mexico Physicians and Surgeons LLC
• Echosierra LLC
• Educare Dental Services, Inc.
• El Rocky Mountain Management & Services, LLC
• Trapper Eldridge, PHARMD
• Victoria M Ellestad, OFFICE ASSISTANT
• Kendra S Elliott, LBSW
• Sumayia Elnur, DDS
• Eldon Embry

• All providers in Clovis, NM
• Family Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.