Individual
AMY KAY LIDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4160
(260) 435-7001
Mailing address
1522 SHADOW RUN TRL, BLUFFTON, IN 46714-1267
(260) 403-1093
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71015963A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/03/2024
Last updated
10/30/2024
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