Healthcare Provider Details

I. General information

NPI: 1124846043
Provider Name (Legal Business Name): AMY FOERG MSN, RN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2904 MILLER DR
PLYMOUTH IN
46563-8083
US

IV. Provider business mailing address

2312 S DIXON RD
KOKOMO IN
46902-6401
US

V. Phone/Fax

Practice location:
  • Phone: 800-342-5653
  • Fax: 260-356-6241
Mailing address:
  • Phone: 765-450-1082
  • Fax: 765-865-0270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number28132761A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: