Provider Demographics
NPI:1700332103
Name:STIMPSON, GRACE-ANNE (MSN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:GRACE-ANNE
Middle Name:
Last Name:STIMPSON
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 AMERICAS PKWY NE STE 200
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-8172
Mailing Address - Country:US
Mailing Address - Phone:505-932-6413
Mailing Address - Fax:715-227-2868
Practice Address - Street 1:6565 AMERICAS PKWY NE STE 200
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-8172
Practice Address - Country:US
Practice Address - Phone:505-932-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179525363LP0808X
TX1000542363LP0808X
NC5008837363LP0808X
CA95015744363LP0808X
FL9344110363LP0808X
COC-APN.0101386-C-NP363LP0808X
NM60360363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health