Healthcare Provider Details

I. General information

NPI: 1831058908
Provider Name (Legal Business Name): SAVANNAH GRACE KING FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10767 ILLINOIS ST
CARMEL IN
46032-8972
US

IV. Provider business mailing address

10767 ILLINOIS ST STE 3000
CARMEL IN
46032-8972
US

V. Phone/Fax

Practice location:
  • Phone: 317-817-1200
  • Fax:
Mailing address:
  • Phone: 317-817-1200
  • Fax: 317-817-1220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71017651A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71017651A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: