Provider Demographics
NPI:1104025691
Name:STANCOMBE, KAREN ARCHER (PNP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ARCHER
Last Name:STANCOMBE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:E
Other - Last Name:ARCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1026
Mailing Address - Country:US
Mailing Address - Phone:317-777-6435
Mailing Address - Fax:317-777-6644
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:RI 5960
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-944-3889
Practice Address - Fax:317-944-3882
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28089486A363LP0200X
IN71002203A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201108350Medicaid
IN201108350Medicaid