Provider Demographics
NPI:1437106499
Name:MILLER, AMY E (FCP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:MILLER
Suffix:
Gender:F
Credentials:FCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7020 DOVE CT
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-8413
Mailing Address - Country:US
Mailing Address - Phone:812-760-1575
Mailing Address - Fax:812-491-8608
Practice Address - Street 1:7020 DOVE CT
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8413
Practice Address - Country:US
Practice Address - Phone:812-760-1575
Practice Address - Fax:812-491-8608
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06542225A00000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200426790Medicaid