Healthcare Provider Details

I. General information

NPI: 1457261554
Provider Name (Legal Business Name): ADRIENNE MCQUISTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADRIENNE SHEPHERD

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 SAGAMORE PKWY W
WEST LAFAYETTE IN
47906-1501
US

IV. Provider business mailing address

253 SAGAMORE PKWY W
WEST LAFAYETTE IN
47906-1501
US

V. Phone/Fax

Practice location:
  • Phone: 765-448-8000
  • Fax: 765-446-7023
Mailing address:
  • Phone: 765-448-8000
  • Fax: 765-446-7023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71018638A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: