Provider Demographics
NPI:1083189146
Name:DINKINS, CARMANNY S (APRN, NP)
Entity Type:Individual
Prefix:
First Name:CARMANNY
Middle Name:S
Last Name:DINKINS
Suffix:
Gender:F
Credentials:APRN, NP
Other - Prefix:
Other - First Name:CARMANNY
Other - Middle Name:S
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:950 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1077
Practice Address - Country:US
Practice Address - Phone:317-963-2200
Practice Address - Fax:317-963-1621
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2024-02-09
Deactivation Date:2019-01-30
Deactivation Code:
Reactivation Date:2019-02-25
Provider Licenses
StateLicense IDTaxonomies
IN71008720A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN264430H04OtherMEDICARE PTAN
ININ1802162OtherMEDICARE
IN300023443Medicaid
IN068010674OtherMEDICARE