Healthcare Provider Details

I. General information

NPI: 1922614965
Provider Name (Legal Business Name): CHILDREN EXPRESS CARE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5435 EMERSON WAY STE 110
INDIANAPOLIS IN
46226-1470
US

IV. Provider business mailing address

5435 EMERSON WAY STE 110
INDIANAPOLIS IN
46226-1470
US

V. Phone/Fax

Practice location:
  • Phone: 317-362-0293
  • Fax: 317-672-4145
Mailing address:
  • Phone: 317-362-0293
  • Fax: 317-672-4145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TAQUITA TOWNSEND
Title or Position: OWNER PROVIDER
Credential: NP
Phone: 317-362-0293