Healthcare Provider Details

I. General information

NPI: 1659216315
Provider Name (Legal Business Name): BRASHEAR PSYCHIATRIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3577 W COCKRELL RD
BLOOMINGTON IN
47403-8710
US

IV. Provider business mailing address

3577 W COCKRELL RD
BLOOMINGTON IN
47403-8710
US

V. Phone/Fax

Practice location:
  • Phone: 812-327-0171
  • Fax:
Mailing address:
  • Phone: 812-327-0171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA JANE BRASHEAR
Title or Position: PMHNP
Credential: APRN
Phone: 812-327-0171