Provider Demographics
NPI:1609035815
Name:METHENY, AMY JOLENE (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:JOLENE
Last Name:METHENY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6263 SHELLY WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-9776
Mailing Address - Country:US
Mailing Address - Phone:317-781-1424
Mailing Address - Fax:317-781-1424
Practice Address - Street 1:6263 SHELLY WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-9776
Practice Address - Country:US
Practice Address - Phone:317-781-1424
Practice Address - Fax:317-781-1424
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01038530A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics