MEDICARE: KRISH LYNNE BONEBRAKE FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	71013921A	IN

General Provider Information

NPI Number	:	1649963364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISH LYNNE BONEBRAKE FNP-C

Provider Business Mailing Address
First Line	:	11530 ALLISONVILLE RD STE 155
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-1862
Country	:	US
Telephone Number	:	317-739-4243
Fax Number	:

Provider Business Practice Location Address
First Line	:	11530 ALLISONVILLE RD STE 155
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-1862
Country	:	US
Telephone Number	:	317-739-4243
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2023
Last Update Date	:	05/30/2023

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