Healthcare Provider Details

I. General information

NPI: 1194359703
Provider Name (Legal Business Name): AMBER M CASSADY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER M SCHMIT

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S LANDMARK AVE
BLOOMINGTON IN
47403-5001
US

IV. Provider business mailing address

PO BOX 1026
INDIANAPOLIS IN
46206-1026
US

V. Phone/Fax

Practice location:
  • Phone: 812-332-9874
  • Fax: 812-335-7604
Mailing address:
  • Phone: 317-777-6435
  • Fax: 317-777-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71009959A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71009959A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: