Healthcare Provider Details

I. General information

NPI: 1487589941
Provider Name (Legal Business Name): KIESHA D CARLISLE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6008 MAGDALENE DR APT B
INDIANAPOLIS IN
46224-8055
US

IV. Provider business mailing address

6008 MAGDALENE DR APT B
INDIANAPOLIS IN
46224-8055
US

V. Phone/Fax

Practice location:
  • Phone: 317-384-9962
  • Fax:
Mailing address:
  • Phone: 317-384-9962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number27082186A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: