NPIMap

Individual provider Active NPI

Amanda Fender, PA-C

  • Physician Assistant
  • Lake City, CO
National Provider Identifier
1932899598
Registry record updated Jun 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0009156 Issued in CO
Practice address
700 N Henson St
Lake City, CO 81235-5134
Phone
(970) 944-2331
Fax
(970) 944-2320
NPI assigned
May 8, 2023
Last updated
Jun 3, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.0009156 CO Primary
Medical Physician Assistant 363AM0700X PA2024-0101 NM

Addresses

Primary practice location

700 N Henson St
Lake City, CO 81235-5134

Mailing address

1329 Gusdorf Rd
Taos, NM 87571-6282
Phone (575) 737-3415

Other practice location 1

1329 Gusdorf Rd
Taos, NM 87571-6282
Phone (575) 737-3415

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20241028001731 NM Practitioner - Physician Assistant 8022541176 Reassigns benefits to 1 organization
I20250516003289 CO Practitioner - Physician Assistant 8022541176 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Taos Professional Services,LLCGroup PAC ID 6507019924, 30 clinicians
Lake Fork Health Services DistrictGroup PAC ID 4981513835, 5 clinicians

Practice addresses (Care Compare)

1397 Weimer Rd
Taos, NM 87571-6253
Phone (575) 751-8902

700 N Henson
Lake City, CO 81235

700 N Henson St
Lake City, CO 81235-5127
Phone (970) 944-2331

721 Wildflower Rd
Lake City, CO 81235-5295

PO Box
Suite 999
Lake City, CO 81235

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA.0009156COMDPhysician Assistant
PA2024-0101NMMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Taos Professional Services, LLC CurrentSince Sep 14, 2024 Accepting new patients
Rocky Mountain University of Health Professions Foundation PastSince Feb 4, 2024 Accepting new patients
Lake City Dental Clinic PastSince Nov 1, 2020 Accepting new patients
Taos Health Systems Inc Holy Cross Past Accepting new patients
Taos Health Systems, Inc., Holy Cross Hospital Past Accepting new patients

Locations

1329 Gusdorf Rd
Taos, NM 87571
Phone (505) 758-5001

1397 Weimer Rd
Taos, NM 87571
Phone (575) 751-5746

Interoperability endpoints

  • Direct secure messaging: amanda.fender.1@19288.direct.athenahealth.com

Organizations & group practices 7

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

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1683504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748908800000",
    "number": "1932899598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1329 GUSDORF RD",
            "city": "TAOS",
            "state": "NM",
            "postal_code": "875716282",
            "telephone_number": "575-737-3415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 N HENSON ST",
            "city": "LAKE CITY",
            "state": "CO",
            "postal_code": "812355134",
            "telephone_number": "970-944-2331",
            "fax_number": "970-944-2320"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1329 Gusdorf Rd",
            "address_purpose": "LOCATION",
            "city": "Taos",
            "state": "NM",
            "postal_code": "875716282",
            "country_code": "US",
            "telephone_number": "575-737-3415",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FENDER",
        "first_name": "AMANDA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-08",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0009156",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NM",
            "license": "PA2024-0101",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, CO

Sources for this page

Verify at the official NPI Registry.