Healthcare Provider Details

I. General information

NPI: 1437854643
Provider Name (Legal Business Name): MARY ELLEN AUSTIN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 MILLIS AVE
BOONVILLE IN
47601-2242
US

IV. Provider business mailing address

1116 MILLIS AVE
BOONVILLE IN
47601-2242
US

V. Phone/Fax

Practice location:
  • Phone: 812-897-7440
  • Fax: 812-897-7444
Mailing address:
  • Phone: 812-897-7440
  • Fax: 812-897-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71013782A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: