Healthcare Provider Details

I. General information

NPI: 1508790742
Provider Name (Legal Business Name): VIKKI MASSIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 N CAPITOL AVE # 2S
INDIANAPOLIS IN
46208-4623
US

IV. Provider business mailing address

3035 N CAPITOL AVE # 2S
INDIANAPOLIS IN
46208-4623
US

V. Phone/Fax

Practice location:
  • Phone: 317-698-9585
  • Fax:
Mailing address:
  • Phone: 317-698-9585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: