Healthcare Provider Details

I. General information

NPI: 1073150918
Provider Name (Legal Business Name): KATIE ELIZABETH ABNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 01/18/2020
Certification Date: 01/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10590 N MERIDIAN ST STE 105
INDIANAPOLIS IN
46290-1028
US

IV. Provider business mailing address

825 S PARK TRAIL DR
CARMEL IN
46032-4219
US

V. Phone/Fax

Practice location:
  • Phone: 317-987-8717
  • Fax:
Mailing address:
  • Phone: 765-210-0801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number71009619A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: