Provider Demographics
NPI:1326014655
Name:REISING, AMY K (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:K
Last Name:REISING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:K
Other - Last Name:REISING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-479-3153
Mailing Address - Fax:812-473-8166
Practice Address - Street 1:6221 PHYSICIANS CT
Practice Address - Street 2:SUITE 1
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4031
Practice Address - Country:US
Practice Address - Phone:812-479-3153
Practice Address - Fax:812-473-8166
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001405A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P78336Medicare UPIN
IN204960CMedicare PIN