Healthcare Provider Details

I. General information

NPI: 1376184556
Provider Name (Legal Business Name): CARRIE MEFFORD PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 E STATE ROAD 44 STE B
SHELBYVILLE IN
46176-1814
US

IV. Provider business mailing address

1818 E STATE ROAD 44 STE B
SHELBYVILLE IN
46176-1814
US

V. Phone/Fax

Practice location:
  • Phone: 317-421-6060
  • Fax: 317-398-0662
Mailing address:
  • Phone: 317-421-6060
  • Fax: 317-398-0662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number28215706A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: