Provider Demographics
NPI:1508587445
Name:WIMBLEDUFF, AMY DENISE (AGNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:DENISE
Last Name:WIMBLEDUFF
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:D
Other - Last Name:KEYS
Other - Suffix:
Other - Last Name Type:Former Name
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 1:3306 LINDEL LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2774
Practice Address - Country:US
Practice Address - Phone:317-557-0980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INAG08220006363LG0600X
IN71013091A363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology