Provider Demographics
NPI:1700275724
Name:THOMPSON, AMANDA LEIGH (FNP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12901 DESERT MOON PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7118
Mailing Address - Country:US
Mailing Address - Phone:505-670-5232
Mailing Address - Fax:
Practice Address - Street 1:1515 EUBANK BLVD SE BLDG 831
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-3453
Practice Address - Country:US
Practice Address - Phone:505-845-8159
Practice Address - Fax:505-845-8190
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007413363LF0000X
NM65678363LF0000X
NC247533163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1700275724Medicaid
NC1700275724Medicaid
NCNCM775BMedicare UPIN