Provider Demographics
NPI:1124846043
Name:FOERG, AMY (MSN, RN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FOERG
Suffix:
Gender:
Credentials:MSN, RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8150 S 100 W
Mailing Address - Street 2:
Mailing Address - City:STAR CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46985-8887
Mailing Address - Country:US
Mailing Address - Phone:765-426-5897
Mailing Address - Fax:
Practice Address - Street 1:8150 S 100 W
Practice Address - Street 2:
Practice Address - City:STAR CITY
Practice Address - State:IN
Practice Address - Zip Code:46985-8887
Practice Address - Country:US
Practice Address - Phone:765-426-5897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28132761A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health