Healthcare Provider Details

I. General information

NPI: 1306198999
Provider Name (Legal Business Name): TISHANN STANTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7465 MADISON AVE
INDIANAPOLIS IN
46227-6564
US

IV. Provider business mailing address

3801 OLD BRUCEVILLE RD
VINCENNES IN
47591-3889
US

V. Phone/Fax

Practice location:
  • Phone: 317-788-3000
  • Fax: 317-788-3005
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number28267029A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number46002334A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: