Healthcare Provider Details

I. General information

NPI: 1922828110
Provider Name (Legal Business Name): AMY LYNN KLEMANN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12315 HANCOCK ST STE 24
CARMEL IN
46032-5885
US

IV. Provider business mailing address

12315 HANCOCK ST STE 24
CARMEL IN
46032-5885
US

V. Phone/Fax

Practice location:
  • Phone: 317-708-3732
  • Fax: 888-316-7962
Mailing address:
  • Phone: 317-708-3732
  • Fax: 888-316-7962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71015828A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28263301A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: