Provider Demographics
NPI:1205826336
Name:RICHMOND, AMY K (ANP, BC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:K
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:ANP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 PEACOCK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-2832
Mailing Address - Country:US
Mailing Address - Phone:765-277-0864
Mailing Address - Fax:
Practice Address - Street 1:801 PEACOCK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-2832
Practice Address - Country:US
Practice Address - Phone:765-277-0864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.07779-NP363LA2200X
IN71001608A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000754326OtherANTHEM
IN200961630Medicaid
IN200961630Medicaid