Healthcare Provider Details

I. General information

NPI: 1124541180
Provider Name (Legal Business Name): AIMEE N BLACK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AIMEE N KRKOSKA NP-C

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13420 N MERIDIAN ST STE 400
CARMEL IN
46032-1581
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-573-7050
  • Fax: 317-573-7098
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71007350A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number28227014A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71007350A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: