Healthcare Provider Details

I. General information

NPI: 1942811682
Provider Name (Legal Business Name): ASHLEE MACK AGACNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 CASTLETON RD
INDIANAPOLIS IN
46250-2007
US

IV. Provider business mailing address

4333 VILLAGE TRACE CT
INDIANAPOLIS IN
46254-6232
US

V. Phone/Fax

Practice location:
  • Phone: 317-449-8284
  • Fax:
Mailing address:
  • Phone: 317-652-9627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71011610A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number71011610A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71011610A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71011610A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: