Healthcare Provider Details

I. General information

NPI: 1235979378
Provider Name (Legal Business Name): MAKAYLA LYDICK WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9240 N MERIDIAN ST STE 270
INDIANAPOLIS IN
46260-1876
US

IV. Provider business mailing address

3400 LAFAYETTE RD STE 200
INDIANAPOLIS IN
46222-1147
US

V. Phone/Fax

Practice location:
  • Phone: 317-294-7422
  • Fax: 317-291-7433
Mailing address:
  • Phone: 317-291-7422
  • Fax: 317-291-7433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number36216
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71018041A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: