Provider Demographics
NPI:1932394087
Name:BEDAN POFF, AMY (MSN NPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BEDAN POFF
Suffix:
Gender:F
Credentials:MSN NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:2051 CLEVIDENCE BLVD STE B
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129
Practice Address - Country:US
Practice Address - Phone:812-280-9145
Practice Address - Fax:502-280-6627
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002491A363L00000X, 363LA2200X
IN28124768A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200905020Medicaid
KY100930OtherSIHO - NCMA
IN71002491AOtherLICENSE
KY000001017617OtherANTHEM - NCMA