Provider Demographics
NPI:1336678192
Name:AUSTIN, LATOYIA CHERDISE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LATOYIA
Middle Name:CHERDISE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LATOYIA
Other - Middle Name:CHERDISE
Other - Last Name:WEBSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2620 E KESSLER BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2889
Mailing Address - Country:US
Mailing Address - Phone:317-734-6934
Mailing Address - Fax:312-530-0054
Practice Address - Street 1:2620 E KESSLER BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2890
Practice Address - Country:US
Practice Address - Phone:317-734-6934
Practice Address - Fax:312-530-0054
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007215A363LF0000X
INF0117016363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28151424AMedicaid