Healthcare Provider Details

I. General information

NPI: 1497933394
Provider Name (Legal Business Name): TRACY M TEIPEN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY LARRISON R.N., B.S.N

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9995 ALLISONVILLE RD
FISHERS IN
46038-2006
US

IV. Provider business mailing address

550 N. UNIVERSITY BLVD. UH 1451
INDPLS IN
46202
US

V. Phone/Fax

Practice location:
  • Phone: 317-442-1093
  • Fax:
Mailing address:
  • Phone: 317-278-1849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number88003402A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28143192A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: