MEDICARE: MRS. AMY ANN HOLBERT NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	28168211A	IN
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	87001712A	IN
3	101YM0800X	Mental Health Counselor	88001890A	IN

General Provider Information

NPI Number	:	1225335821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY ANN HOLBERT NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	3901 S 7TH ST
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47802-5709
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 HOSPITAL LN
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47802-4247
Country	:	US
Telephone Number	:	812-232-0021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2011
Last Update Date	:	11/29/2023

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