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NPI Code Detail

MEDICARE: MRS. ASHLEE MACK AGACNP, PMHNP

MEDICARE: MRS. ASHLEE MACK AGACNP, PMHNP
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
1363LA2100XAcute Care Nurse Practitioner71011610AIN
2363LG0600XGerontology Nurse Practitioner71011610AIN
3363LP0808XPsychiatric/Mental Health Nurse Practitioner71011610AIN
4363L00000XNurse Practitioner71011610AIN

General Provider Information

NPI Number : 1942811682
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ASHLEE MACK AGACNP, PMHNP
Provider Business Mailing Address
First Line : 4333 VILLAGE TRACE CT
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46254-6232
Country : US
Telephone Number : 317-652-9627
Fax Number :
Provider Business Practice Location Address
First Line : 6330 DIGITAL WAY
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46278-1667
Country : US
Telephone Number : 800-523-5222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2020
Last Update Date : 06/02/2025

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