MARK AMBA STANDLEY (NPI# 1114445590) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114445590 |
| Entity Type | Individual |
| Full Name | MARK AMBA STANDLEY |
| Credential | PA-C |
| Practice Address |
111 W Hobbs St Roswell NM 88203-1869 |
| Mailing Address |
8101 Lamount Dr Amarillo TX 79110-4615 |
| Practice Telephone | 5756233311 |
| Mailing Telephone | 8066761523 |
| Enumeration Date | 2017-09-06 |
| Last Update Date | 2019-03-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA2018-0080 | NM | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
111 W HOBBS ST |
| City | ROSWELL |
| State | NM |
| Zip Code | 88203-1869 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093778839 | Jane Marie Gilbreth | Family Medicine | 111 W Hobbs St, Roswell, NM 88203-1869 | 2006-04-11 |
| 1184233132 | Tracy Nicholle Bell | Registered Nurse | 111 W Hobbs St, Roswell, NM 88203-1869 | 2020-07-27 |
| 1528603602 | Amy Lynn Wishard | Nurse Practitioner | 111 W Hobbs St, Roswell, NM 88203-1869 | 2019-11-12 |
| 1093282246 | Rachel M Schupp | Nurse Practitioner | 111 W Hobbs St, Roswell, NM 88203-1869 | 2018-10-25 |
| 1285119651 | Jennifer May | Nurse Practitioner | 111 W Hobbs St, Roswell, NM 88203-1869 | 2018-10-01 |
| 1619346376 | Thomas Black | Nurse Practitioner | 111 W Hobbs St, Roswell, NM 88203-1869 | 2015-09-23 |
| 1629145792 | Kelley Pharmacy | Pharmacy | 111 W Hobbs St, Roswell, NM 88203-1869 | 2006-11-30 |
| 1487688792 | Jo Ann Whiteman | Family Medicine | 111 W Hobbs St, Roswell, NM 88203-1869 | 2006-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770115586 | Katherine Bolin | Behavior Technician | 333 West Brasher Rd. #200, Roswell, NM 88203 | 2020-02-10 |
| 1437660040 | Pecos Valley Eye Surgery Center, LLC | Clinic/Center | 1610 Se Main Street, Roswell, NM 88203 | 2017-10-23 |
| 1285031286 | Wheelchair and Walker Rentals, Inc. | Durable Medical Equipment & Medical Supplies | 305 W Mcgaffey St, Roswell, NM 88203 | 2014-11-20 |
| 1447585914 | Whole World Health Care, PC | Pediatrics | 109 W. Bland, Roswell, NM 88203 | 2009-10-16 |
| 1780825372 | Complete Rehab Adult Services | Clinic/Center | 109 W Bland, Roswell, NM 88203 | 2009-03-12 |
| 1710127220 | Roswell Medical Care | Health Maintenance Organization | 111 W Hobbs, Roswell, NM 88203 | 2009-02-23 |
| 1336330513 | Savitri Aguiar | Internal Medicine | 1511 South Grand, Roswell, NM 88203 | 2007-08-05 |
| 1750455523 | Francisco Casio Bicol Jr. | Occupational Therapist | 200 W 1st St Ste 527, Roswell, NM 88203 | 2006-11-20 |
| 1699861542 | Susan Lee Voigt | Counselor | 200 W 1st, Ste 532, Roswell, NM 88203 | 2006-10-05 |
| 1245336940 | Founders Healthcare LLC | Durable Medical Equipment & Medical Supplies | 104 N Missouri Ave, Roswell, NM 88203 | 2006-09-16 |
| Find all providers in zip 88203 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790232031 | Christina Danielle Dicioccio | Physician Assistant | 11040 Crabapple Rd # Suiea, Roswell, GA 30075 | 2016-09-02 |
| 1598934481 | Andrew Neil Wasserberg | Physician Assistant | 400 N. Pennsylvania Ave, Suite 101, Roswell, NM 88201 | 2008-02-25 |
| 1073572954 | Thomas Alan Geckler | Physician Assistant | 500 Sun Valley Dr, Suite A-2, Roswell, GA 30076-1482 | 2006-03-21 |
| 1861481335 | Anna Marie Bauer | Physician Assistant | 1289 Hembree Rd, Suite 200-a, Roswell, GA 30076 | 2005-10-18 |
| 1841287471 | Carrie Flury | Physician Assistant | 712 W Hobbs St, Roswell, NM 88203-3646 | 2005-09-29 |
| 1538674650 | Carla Perry-davis | Physician Assistant | 1357 Hembree Rd Ste 200, Roswell, GA 30076-5710 | 2017-12-12 |
| 1760833388 | Kandace Suzette Mcclellan | Physician Assistant | 300 W Country Club Rd Ste 230, Roswell, NM 88201-5240 | 2016-06-24 |
| 1801203666 | Kimberly Ann Donahue | Physician Assistant | 1825 Old Alabama Rd, Suite 201, Roswell, GA 30076-2273 | 2014-07-14 |
| 1205267432 | Norman Bowers | Physician Assistant | 303 W Country Club Rd, Roswell, NM 88201-5892 | 2013-12-13 |
| 1932539293 | Kingel N Desai | Physician Assistant | 1340 Upper Hembree Rd Ste A, Roswell, GA 30076 | 2013-11-22 |
| Find all providers in ROSWELL | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.