MEDICARE: RANDALL S. GARING NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	71012621A	IN
2	163W00000X	Registered Nurse	28251265A	IN
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	71012621A	IN

General Provider Information

NPI Number	:	1336878628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDALL S. GARING NP

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 N SENATE BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1239
Country	:	US
Telephone Number	:	317-962-2690
Fax Number	:	317-963-5111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2022
Last Update Date	:	01/05/2026

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