Provider Demographics
NPI:1194455766
Name:RAGSDALE, AMANDEEP KAUR (NP)
Entity type:Individual
Prefix:
First Name:AMANDEEP
Middle Name:KAUR
Last Name:RAGSDALE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMANDEEP
Other - Middle Name:
Other - Last Name:KAUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1701 N SENATE BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1239
Practice Address - Country:US
Practice Address - Phone:317-962-5339
Practice Address - Fax:317-962-2082
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012593A363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN233690225OtherMEDICARE PTAN
IN300063878Medicaid