Healthcare Provider Details

I. General information

NPI: 1336678192
Provider Name (Legal Business Name): LATOYIA CHERDISE AUSTIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LATOYIA CHERDISE WEBSTER RN

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 E KESSLER BLVD
INDIANAPOLIS IN
46220-2890
US

IV. Provider business mailing address

2620 E KESSLER BLVD STE 110
INDIANAPOLIS IN
46220-2889
US

V. Phone/Fax

Practice location:
  • Phone: 317-734-6934
  • Fax: 312-530-0054
Mailing address:
  • Phone: 317-734-6934
  • Fax: 312-530-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71007215A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberF0117016
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: