Healthcare Provider Details

I. General information

NPI: 1538045935
Provider Name (Legal Business Name): AMBER PUCKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3412 N 400 W
GREENFIELD IN
46140-8082
US

IV. Provider business mailing address

3412 N 400 W
GREENFIELD IN
46140-8082
US

V. Phone/Fax

Practice location:
  • Phone: 317-445-9480
  • Fax:
Mailing address:
  • Phone: 317-445-9480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: