Provider Demographics
NPI:1952693822
Name:RATLIFF KESSENS, AMY RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:RUTH
Last Name:RATLIFF KESSENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:RUTH
Other - Last Name:RATLIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4935 W ARLINGTON RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-1187
Practice Address - Country:US
Practice Address - Phone:812-353-3800
Practice Address - Fax:812-353-3770
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01073999A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201097660Medicaid