MEDICARE: ELYSE SIPKA 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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	71011664A	IN

General Provider Information

NPI Number	:	1760154934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELYSE SIPKA PMHNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 30134
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46230-0134
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 N SHADELAND AVE STE 250
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-1712
Country	:	US
Telephone Number	:	317-355-5009
Fax Number	:

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

Provider Enumeration Date	:	10/05/2021
Last Update Date	:	01/11/2026

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