Healthcare Provider Details

I. General information

NPI: 1346000957
Provider Name (Legal Business Name): RENADA CAPRICE LOTT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6191 N KEYSTONE AVE
INDIANAPOLIS IN
46220-2423
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-257-6746
  • Fax:
Mailing address:
  • Phone: 317-621-7584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71015088A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: