Provider Demographics
NPI:1235572124
Name:MOUNT, KRISTY (MD/PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:
Last Name:MOUNT
Suffix:
Gender:F
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SOUTHFIELD DR STE 1310
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4499
Mailing Address - Country:US
Mailing Address - Phone:317-839-7741
Mailing Address - Fax:317-839-7749
Practice Address - Street 1:1100 SOUTHFIELD DR STE 1310
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-4499
Practice Address - Country:US
Practice Address - Phone:317-839-7741
Practice Address - Fax:317-839-7749
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11017416A207Q00000X
IN01074340A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine