Provider Demographics
NPI:1114015302
Name:CARTER, MICHELLE L (APN, NPA, RN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:CARTER
Suffix:
Gender:F
Credentials:APN, NPA, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-621-7561
Mailing Address - Fax:317-355-6096
Practice Address - Street 1:322 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-4622
Practice Address - Country:US
Practice Address - Phone:765-453-8555
Practice Address - Fax:765-453-8114
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002227B APN CSR364SP0808X
IN71002227363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28116710AOtherRN
IN71002227AOtherNURSE PRACTITIONER AUTHOR
IN71002227BOtherAPN CSR
IN28116710AOtherRN
ININ2504007Medicare PIN