Healthcare Provider Details

I. General information

NPI: 1477859742
Provider Name (Legal Business Name): MERCY MOTO APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2011
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7962 OAKLANDON RD STE 104
INDIANAPOLIS IN
46236-7502
US

IV. Provider business mailing address

7962 OAKLANDON RD STE 104
INDIANAPOLIS IN
46236-7502
US

V. Phone/Fax

Practice location:
  • Phone: 317-676-9952
  • Fax: 317-647-4375
Mailing address:
  • Phone: 317-676-9952
  • Fax: 317-647-4375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number07004940A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71004940A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: