Healthcare Provider Details

I. General information

NPI: 1285345439
Provider Name (Legal Business Name): ABBEY KREAGER AGACNP-DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBEY LARR

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 E DISCOVERY PKWY
BLOOMINGTON IN
47408-9059
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 812-331-3400
  • Fax: 812-332-7265
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704337869
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number71013670A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: