Provider Demographics
NPI:1962709105
Name:MARTIN, AMY STUTTS (APRN)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:STUTTS
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N UNION AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-4194
Mailing Address - Country:US
Mailing Address - Phone:830-606-9111
Mailing Address - Fax:
Practice Address - Street 1:600 N UNION AVE
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4194
Practice Address - Country:US
Practice Address - Phone:830-606-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH091158-23363LA2100X
SC24455363LA2100X
TXAP119277363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1962709105OtherBLUE CROSS BLUE SHIELD
TXP01078366OtherRR MEDICARE
TX281650601Medicaid
TX281650602Medicaid
SCNP7298Medicaid
TX1962709105OtherBLUE CROSS BLUE SHIELD