Healthcare Provider Details

I. General information

NPI: 1457456659
Provider Name (Legal Business Name): ALTA M. SKELTON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 W CARMEL DR SUITE 150
CARMEL IN
46032-5877
US

IV. Provider business mailing address

755 W CARMEL DR SUITE 150
CARMEL IN
46032-5877
US

V. Phone/Fax

Practice location:
  • Phone: 317-810-1399
  • Fax: 317-810-1391
Mailing address:
  • Phone: 317-810-1399
  • Fax: 317-810-1391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28119508A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71001461A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number71001461
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: