Provider Demographics
NPI:1093127607
Name:BRATTON, AMANDA (ANP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BRATTON
Suffix:
Gender:
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W RAMPART ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-8846
Mailing Address - Country:US
Mailing Address - Phone:317-421-2012
Mailing Address - Fax:317-398-1851
Practice Address - Street 1:2451 INTELLIPLEX DR STE 205
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8581
Practice Address - Country:US
Practice Address - Phone:317-421-1914
Practice Address - Fax:317-398-1853
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004992A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201246180Medicaid
IN201246180Medicaid