Provider Demographics
NPI:1780491639
Name:PRYOR, AMY LAREA (PMH-NP-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LAREA
Last Name:PRYOR
Suffix:
Gender:F
Credentials:PMH-NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 PARKVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-7630
Mailing Address - Country:US
Mailing Address - Phone:909-363-6861
Mailing Address - Fax:
Practice Address - Street 1:1901 PARKVIEW BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-7630
Practice Address - Country:US
Practice Address - Phone:909-363-6861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.1000335-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health