Provider Demographics
NPI:1982080347
Name:HAMMONS, MARCIA WATTS (AG-ACNP-BC)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:WATTS
Last Name:HAMMONS
Suffix:
Gender:F
Credentials:AG-ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 MALL DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8128
Mailing Address - Country:US
Mailing Address - Phone:575-521-3270
Mailing Address - Fax:575-521-3504
Practice Address - Street 1:1160 MALL DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8128
Practice Address - Country:US
Practice Address - Phone:575-521-3270
Practice Address - Fax:575-521-3504
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128720363LA2100X, 363LG0600X, 363LA2200X
NMCNP-02766363LG0600X, 363LA2200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM91734576Medicaid