Healthcare Provider Details

I. General information

NPI: 1811225717
Provider Name (Legal Business Name): KRISTI JO NISSLEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2759 STATE ROAD 37
MITCHELL IN
47446
US

IV. Provider business mailing address

2759 STATE ROAD 37
MITCHELL IN
47446-6016
US

V. Phone/Fax

Practice location:
  • Phone: 812-849-6420
  • Fax:
Mailing address:
  • Phone: 812-992-5440
  • Fax: 812-992-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003156A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: