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General NPI Number Information
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NPI Number | 1770130122
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Entity Type | Individual
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Provider Name | AMY MARIE MARTIN PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/21/2019
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 1802 E 10TH ST
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-6016
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Country | US
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Telephone | 812-288-2488
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Fax | 812-288-6603
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Provider Business Mailing Address
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Address Line | PO BOX 776347
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City | CHICAGO
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State | IL
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Zip | 60677-6347
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5339
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 71011592A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 3013704
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License Number State | KY
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