Healthcare Provider Details

I. General information

NPI: 1902594070
Provider Name (Legal Business Name): MARK ANDREW ATKINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14403 GLAPTHORN RD
FISHERS IN
46037-7423
US

IV. Provider business mailing address

14403 GLAPTHORN RD
FISHERS IN
46037-7423
US

V. Phone/Fax

Practice location:
  • Phone: 317-525-5343
  • Fax:
Mailing address:
  • Phone: 317-525-5343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28258550A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71014034A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: