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General NPI Number Information
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NPI Number | 1114476611
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Entity Type | Individual
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Provider Name | KARISSA EICKHOFF PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/25/2016
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 740 W GREEN MEADOWS DR STE 110
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City | GREENFIELD
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State | IN
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Zip | 46140-3098
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Country | US
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Telephone | 317-318-7030
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Fax | 317-318-7045
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Provider Business Mailing Address
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Address Line | 6626 E 75TH ST STE 500
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2890
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9115876
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10002164A
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License Number State | IN
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