Provider Demographics
NPI:1184390460
Name:VERNON, AMANDA (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:VERNON
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 1:1349 N OLIVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:PARAGON
Mailing Address - State:IN
Mailing Address - Zip Code:46166-9263
Mailing Address - Country:US
Mailing Address - Phone:317-874-8843
Mailing Address - Fax:
Practice Address - Street 1:1349 N OLIVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:PARAGON
Practice Address - State:IN
Practice Address - Zip Code:46166-9263
Practice Address - Country:US
Practice Address - Phone:317-874-8843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011409B363LP0808X
IN71011409A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health