Healthcare Provider Details

I. General information

NPI: 1639042252
Provider Name (Legal Business Name): HYE KYONG NAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 08/09/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6032 NORWALDO AVE
INDIANAPOLIS IN
46220-2346
US

IV. Provider business mailing address

6032 NORWALDO AVE
INDIANAPOLIS IN
46220-2346
US

V. Phone/Fax

Practice location:
  • Phone: 407-267-6113
  • Fax:
Mailing address:
  • Phone: 407-267-6113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN9206106
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN9206106
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: