Provider Demographics
NPI:1457002669
Name:SHUPE, AMBER RAE (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:RAE
Last Name:SHUPE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:RAE
Other - Last Name:SHUPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4904 M AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:IA
Mailing Address - Zip Code:51037-7002
Mailing Address - Country:US
Mailing Address - Phone:712-229-5381
Mailing Address - Fax:
Practice Address - Street 1:1525 W 5TH ST
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-3027
Practice Address - Country:US
Practice Address - Phone:712-213-8656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA128463363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health