Provider Demographics
NPI:1518639640
Name:GOODPASTER, AMY (MSN- FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GOODPASTER
Suffix:
Gender:F
Credentials:MSN- FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:583 WINDBOROUGH
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-9341
Mailing Address - Country:US
Mailing Address - Phone:317-965-6260
Mailing Address - Fax:
Practice Address - Street 1:11495 N PENN ST STE 270
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5636
Practice Address - Country:US
Practice Address - Phone:317-938-4559
Practice Address - Fax:317-527-4704
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011641A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1518639640.OtherNPI