Provider Demographics
NPI:1366846453
Name:DRAPER-POE, AMY LEIGH (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LEIGH
Last Name:DRAPER-POE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 S. MAIN STREET SUITE 200
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IN
Practice Address - Zip Code:46072-9596
Practice Address - Country:US
Practice Address - Phone:765-675-1400
Practice Address - Fax:765-675-1401
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28194627A363LF0000X
IN71005203A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201271550Medicaid
IN201271550Medicaid