=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124973532
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COURTNEY CREATER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2026
-----------------------------------------------------
Last Update Date | 03/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4410 THORNLEIGH DR
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46226-2166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-987-5337
-----------------------------------------------------
Fax | 317-932-5467
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4410 THORNLEIGH DR
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46226-2166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-987-5337
-----------------------------------------------------
Fax | 317-932-5467
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number | 016694
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------