Individual
MRS. AMY MARIE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
1802 E 10TH ST, JEFFERSONVILLE, IN 47130-6016
(812) 288-2488
(812) 288-6603
Mailing address
PO BOX 776347, CHICAGO, IL 60677-6347
(502) 588-9490
(502) 272-5339
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
3013704
KY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
71011592A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300061493
—
IN
05
—
7100619340
—
KY
01
—
IN3604072
MEDICARE
IN
Enumeration date
08/21/2019
Last updated
12/26/2024
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