Healthcare Provider Details

I. General information

NPI: 1699604611
Provider Name (Legal Business Name): KAITLYN SANDERSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9761 CROSSPOINT BLVD STE 500
INDIANAPOLIS IN
46256-3800
US

IV. Provider business mailing address

9761 CROSSPOINT BLVD STE 500
INDIANAPOLIS IN
46256-3800
US

V. Phone/Fax

Practice location:
  • Phone: 317-516-5127
  • Fax: 317-516-5906
Mailing address:
  • Phone: 317-516-5127
  • Fax: 317-516-5906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28266907A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: