Healthcare Provider Details

I. General information

NPI: 1376867598
Provider Name (Legal Business Name): AMANDA LYNN STARKS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 25TH ST
BEDFORD IN
47421-5000
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 812-277-0118
  • Fax: 812-277-0127
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71003206A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: