Healthcare Provider Details

I. General information

NPI: 1285529263
Provider Name (Legal Business Name): KRISTINA MARIE HICKS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N SENATE AVE
INDIANAPOLIS IN
46202-5306
US

IV. Provider business mailing address

5553 PAINTED MAPLE CT
INDIANAPOLIS IN
46254-9630
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-2000
  • Fax:
Mailing address:
  • Phone: 317-771-9376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number71016686A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71016686A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: