| Doctor Name: | AMY JENE ELLINGWOOD |
| NPI Number: | 1235486499 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ANP |
| License Number: | 2012011503 |
| Business Practice Address: | 1630 Lafayette Rd Suite 200 Crawfordsville, IN - 479331090 |
| Business Phone Number: | 7653592230 |
| Business Fax Number: | 7653592236 |
| Mailing Address: | 1630 Lafayette Rd, Suite 200 CRAWFORDSVILLE |
| State: | IN |
| Postal Code: | 479331090 |
| Phone Number: | 7653592230 |
| Fax Number: | 7653592236 |
| NPI Enumeration Date: | 08/07/2012 |
| NPI Last Update Date: | 08/07/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 2012011503 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |