Provider Demographics
NPI:1063662252
Name:MOWERY, AMY (NNP)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:MOWERY
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:MOWERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NNP
Mailing Address - Street 1:8091 TOWNSHIP LINE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2494
Mailing Address - Country:US
Mailing Address - Phone:317-415-7921
Mailing Address - Fax:317-415-7922
Practice Address - Street 1:8091 TOWNSHIP LINE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2494
Practice Address - Country:US
Practice Address - Phone:317-415-7921
Practice Address - Fax:317-415-7922
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002817A363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care