Provider Demographics
NPI:1366616419
Name:HERRON MILLER, AMY CHARTERS (MS, APN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CHARTERS
Last Name:HERRON MILLER
Suffix:
Gender:F
Credentials:MS, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6229 LOGANSPORT RD
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-8867
Mailing Address - Country:US
Mailing Address - Phone:574-721-5449
Mailing Address - Fax:
Practice Address - Street 1:10801 N MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-8170
Practice Address - Country:US
Practice Address - Phone:317-732-9550
Practice Address - Fax:317-203-0929
Is Sole Proprietor?:No
Enumeration Date:2008-04-19
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009257A363LP0808X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health