Healthcare Provider Details

I. General information

NPI: 1235856949
Provider Name (Legal Business Name): DONNA STORY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DONNA KNIGHT

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10475 CROSSPOINT BLVD
INDIANAPOLIS IN
46256-3386
US

IV. Provider business mailing address

1424 SANDY BAY DR APT L
GREENWOOD IN
46142-2174
US

V. Phone/Fax

Practice location:
  • Phone: 615-570-9959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: