Healthcare Provider Details

I. General information

NPI: 1598884157
Provider Name (Legal Business Name): KIMBERLY A. GRIFFITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY A. MINNICK

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8402 HARCOURT RD STE 830
INDIANAPOLIS IN
46260-2096
US

IV. Provider business mailing address

13345 ILLINOIS ST
CARMEL IN
46032-3318
US

V. Phone/Fax

Practice location:
  • Phone: 317-396-1300
  • Fax: 317-396-1480
Mailing address:
  • Phone: 317-396-1300
  • Fax: 317-396-1480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number28149142A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71001981A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: