Provider Demographics
NPI:1639842701
Name:TAYLOR, AMY J (MHNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1252
Mailing Address - Country:US
Mailing Address - Phone:812-421-7489
Mailing Address - Fax:812-436-0209
Practice Address - Street 1:401 JOHN ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-2733
Practice Address - Country:US
Practice Address - Phone:812-492-8333
Practice Address - Fax:812-492-8333
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011353A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300054100Medicaid