Healthcare Provider Details

I. General information

NPI: 1255660528
Provider Name (Legal Business Name): MARY AMBER ERVIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY AMBER ERVIN OTR/L

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 STATE ST
NEW ALBANY IN
47150-4990
US

IV. Provider business mailing address

PO BOX 185
FLOYDS KNOBS IN
47119-0185
US

V. Phone/Fax

Practice location:
  • Phone: 502-724-8135
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10004673B
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberR4333
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: