Provider Demographics
NPI:1013997014
Name:MEREDITH, AMANDA LYNN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LYNN
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:HORST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:250 W 96TH ST # 520
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2015 JACKSON ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4337
Practice Address - Country:US
Practice Address - Phone:765-609-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00420700363A00000X
IN10002656A363AM0700X
OH50.003307363AM0700X
NE1042363AM0700X
NY020841-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE38594OtherBCBSNE
NEP00360225Medicare PIN
NE098147024Medicare PIN
NE279949Medicare PIN