Healthcare Provider Details

I. General information

NPI: 1902115090
Provider Name (Legal Business Name): AMY REBECCA CLAYTON ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10590 N MERIDIAN ST STE 105
CARMEL IN
46290-1028
US

IV. Provider business mailing address

7851 WHITE RIVER DR
INDIANAPOLIS IN
46240-2775
US

V. Phone/Fax

Practice location:
  • Phone: 317-583-7800
  • Fax:
Mailing address:
  • Phone: 317-294-7804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71003414A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: