Provider Demographics
NPI:1619227642
Name:DIPPEL, AMY M (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:DIPPEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2140
Mailing Address - Country:US
Mailing Address - Phone:317-346-2700
Mailing Address - Fax:317-346-2701
Practice Address - Street 1:1125 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2140
Practice Address - Country:US
Practice Address - Phone:317-346-2700
Practice Address - Fax:317-346-2701
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004149A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201112030Medicaid
IN2768003OtherMEDICARE
IN264430122Medicare PIN