Healthcare Provider Details

I. General information

NPI: 1619288560
Provider Name (Legal Business Name): KRISTIN ANN HALPERN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN ANN DANIELSON

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 05/12/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13345 ILLINOIS ST.
CARMEL IN
46032-5924
US

IV. Provider business mailing address

13345 ILLINOIS ST.
CARMEL IN
46032-3318
US

V. Phone/Fax

Practice location:
  • Phone: 317-396-1300
  • Fax: 317-876-4070
Mailing address:
  • Phone: 317-396-1300
  • Fax: 317-352-3417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10001183A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: