MEDICARE: AMY KORNHAUSER FNP-BC

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	71009234A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770137598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY KORNHAUSER FNP-BC

Provider Business Mailing Address
First Line	:	4151 E 96TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1442
Country	:	US
Telephone Number	:	866-434-3255
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 AMERICAN SQ STE B1-10
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46282-0020
Country	:	US
Telephone Number	:	317-522-8044
Fax Number	:	765-650-7803

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

Provider Enumeration Date	:	07/30/2019
Last Update Date	:	01/26/2026

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