Healthcare Provider Details

I. General information

NPI: 1649744210
Provider Name (Legal Business Name): HEIDI KATE O'NEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 N MERIDIAN ST STE 102
INDIANAPOLIS IN
46202-1358
US

IV. Provider business mailing address

2105 N MERIDIAN ST STE 102
INDIANAPOLIS IN
46202-1358
US

V. Phone/Fax

Practice location:
  • Phone: 317-926-5463
  • Fax:
Mailing address:
  • Phone: 317-926-5463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: