Healthcare Provider Details

I. General information

NPI: 1992291264
Provider Name (Legal Business Name): KRYSTA GRAHAM FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13121 OLIO RD STE 300
FISHERS IN
46037-7240
US

IV. Provider business mailing address

14185 AVALON EAST DR
FISHERS IN
46037-6201
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-1300
  • Fax: 317-621-1310
Mailing address:
  • Phone: 317-748-1072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008144A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: