Healthcare Provider Details

I. General information

NPI: 1124998794
Provider Name (Legal Business Name): AMY SUE NEWKIRK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3814 WILLIARD DR
JEFFERSONVILLE IN
47130-8774
US

IV. Provider business mailing address

3814 WILLIARD DR
JEFFERSONVILLE IN
47130-8774
US

V. Phone/Fax

Practice location:
  • Phone: 765-423-7988
  • Fax: 844-689-1205
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: