Provider Demographics
NPI:1568232189
Name:FALKENSTEIN, AMY DIANE (PMHNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:DIANE
Last Name:FALKENSTEIN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MAIN ST UNIT 165
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-3117
Mailing Address - Country:US
Mailing Address - Phone:812-207-3426
Mailing Address - Fax:
Practice Address - Street 1:1400 MAIN ST UNIT 165
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-3117
Practice Address - Country:US
Practice Address - Phone:812-207-3426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71014693A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health