Individual provider Active NPI

Amanda Roberts, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Kokomo, IN
National Provider Identifier
1891466843
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
71011683A Issued in IN
Practice address
3900 Southland Ave
Kokomo, IN 46902-3689
Phone
(317) 876-3699
Fax
(765) 453-3773
NPI assigned
Sep 21, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 71011683B IN
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 71011683A IN Primary

Addresses

Primary practice location

3900 Southland Ave
Kokomo, IN 46902-3689

Mailing address

3900 Southland Ave
Kokomo, IN 46902-3689

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
I20211025001363 IN Practitioner - Nurse Practitioner 8527456524 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mending Minds, LLCGroup PAC ID 4284037987, 15 clinicians

Practice addresses (Care Compare)

1311 W 96TH St
Suite 110
Indianapolis, IN 46260-1172
Phone (317) 876-3699

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
71011683AINMDPsychiatric/Mental Health Nurse Practitioner
71011683BINMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mending Minds, LLC CurrentSince Jul 12, 2024 Accepting new patients
Aspire Indiana Health Inc. Current Accepting new patients

Locations

2009 Brown St
Anderson, IN 46016
Phone (765) 393-3891

215 W 19th St
Anderson, IN 46016
Phone (765) 393-3891

1311 W 96th St
Ste 110
Indianapolis, IN 46260
Phone (317) 296-7707

3900 Southland Ave
Kokomo, IN 46902
Phone (317) 876-3699

9615 E 148th St
Ste 1
Noblesville, IN 46060
Phone (317) 587-0500

17840 Cumberland Rd
Noblesville, IN 46060
Phone (317) 773-6864

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24167/brand/1/csg/1/fhir/r4
  • Direct secure messaging: amanda.roberts.1@24167.direct.athenahealth.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1632182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1891466843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 SOUTHLAND AVE",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469023689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 SOUTHLAND AVE",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469023689",
            "telephone_number": "317-876-3699",
            "fax_number": "765-453-3773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "AMANDA",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-21",
        "last_updated": "2025-04-17",
        "certification_date": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71011683B",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71011683A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kokomo, IN

Sources for this page

Verify at the official NPI Registry.