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NPI Code Detail

MEDICARE: KRISTIN JEAN CLYNE ANP, PMHNP-BC

MEDICARE: KRISTIN JEAN CLYNE ANP, PMHNP-BC
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
1363LA2200XAdult Health Nurse Practitioner71003352AIN
2363LP0808XPsychiatric/Mental Health Nurse Practitioner71003352AIN

General Provider Information

NPI Number : 1477860997
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN JEAN CLYNE ANP, PMHNP-BC
Provider Business Mailing Address
First Line : 1311 W 96TH ST STE 110
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-1172
Country : US
Telephone Number : 317-876-3699
Fax Number : 317-876-3600
Provider Business Practice Location Address
First Line : 1311 W 96TH ST STE 110
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-1172
Country : US
Telephone Number : 317-876-3699
Fax Number : 317-876-3600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2010
Last Update Date : 04/18/2025

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Directions to “ KRISTIN JEAN CLYNE ANP, PMHNP-BC” Practice Location

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