Provider Demographics
NPI:1104124163
Name:FRANKLIN, AMANDA ELLEN (FNP-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELLEN
Last Name:FRANKLIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:E
Other - Last Name:HORST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:528 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1402
Mailing Address - Country:US
Mailing Address - Phone:812-882-4434
Mailing Address - Fax:812-885-6318
Practice Address - Street 1:528 N 1ST ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1402
Practice Address - Country:US
Practice Address - Phone:812-882-4434
Practice Address - Fax:812-885-6318
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003554A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN783687OtherANTHEM
IN201012590Medicaid
IN201012590Medicaid