Provider Demographics
NPI:1639957681
Name:CARLOCK, AMANDA HOPE (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:HOPE
Last Name:CARLOCK
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10345 CARRINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-2578
Mailing Address - Country:US
Mailing Address - Phone:574-444-8724
Mailing Address - Fax:
Practice Address - Street 1:5230 E STOP 11 RD STE 300
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6401
Practice Address - Country:US
Practice Address - Phone:317-961-5173
Practice Address - Fax:317-961-5183
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28208733A163W00000X
IN71014449A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse