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General NPI Number Information
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NPI Number | 1881484962
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Entity Type | Individual
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Provider Name | ISREAL KIRK HUNTER WAKEFIELD SR. PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 8103 E US HIGHWAY 36 227
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City | AVON
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State | IN
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Zip | 46123-7964
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Country | US
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Telephone | 317-838-5693
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Fax |
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Provider Business Mailing Address
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Address Line | 8103 EAST HIGHWAY 36 PMB 227
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City | AVON
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State | IN
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Zip | 46123
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Country | US
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Telephone | 317-838-5693
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 28193439A
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License Number State | IN
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