Individual provider Active NPI

Amy Kay Liddy, FNP-C

  • Nurse Practitioner
  • Fort Wayne, IN
National Provider Identifier
1114752888
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
71015963A Issued in IN
Practice address
7950 W Jefferson Blvd
Fort Wayne, IN 46804-4160
Phone
(260) 435-7001
NPI assigned
Sep 3, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Nurse Practitioner 363L00000X 71015963A IN Primary

Addresses

Primary practice location

7950 W Jefferson Blvd
Fort Wayne, IN 46804-4160

Mailing address

1522 Shadow Run TRL
Bluffton, IN 46714-1267
Phone (260) 403-1093

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250207001833 IN Practitioner - Nurse Practitioner 3072043926 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hospitalist Physicians of Indiana PCGroup PAC ID 1052795986, 148 clinicians

Practice addresses (Care Compare)

7950 W Jefferson Blvd
Lutheran Hospital of Indiana
Fort Wayne, IN 46804-4140
Phone (260) 435-7001

Hospital & facility affiliations

  • Lutheran Hospital of Indiana Hospital, Fort Wayne, IN, CCN 150017
  • The Orthopaedic Hospital of Lutheran Health Networ Hospital, Ft Wayne, IN, CCN 150168

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hospitalist Physicians of Indiana, PC Nurse Practitioner CurrentSince Jan 1, 2025 Accepting new patients

Locations

7950 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 434-7088

702 Van Buren St
Fort Wayne, IN 46802
Phone (260) 425-3000

1850 State St
New Albany, IN 47150
Phone (812) 944-7701

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1725321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1114752888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1522 SHADOW RUN TRL",
            "city": "BLUFFTON",
            "state": "IN",
            "postal_code": "467141267",
            "telephone_number": "260-403-1093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7950 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044160",
            "telephone_number": "260-435-7001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIDDY",
        "first_name": "AMY",
        "middle_name": "KAY",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-03",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71015963A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.