Healthcare Provider Details

I. General information

NPI: 1962104760
Provider Name (Legal Business Name): ASIA ATKINSON PMHNP, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 SOUTHFIELD DR
PLAINFIELD IN
46168-2955
US

IV. Provider business mailing address

400 DOUBLE CREEK DR APT 203
PLAINFIELD IN
46168-5582
US

V. Phone/Fax

Practice location:
  • Phone: 219-742-0953
  • Fax:
Mailing address:
  • Phone: 219-742-0953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71013709A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: