Provider Demographics
NPI:1437648755
Name:MEDLER, KRISIE L (AGACNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISIE
Middle Name:L
Last Name:MEDLER
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:KRISIE
Other - Middle Name:L
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 MARY ST STE 520
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1682
Mailing Address - Country:US
Mailing Address - Phone:812-424-8231
Mailing Address - Fax:
Practice Address - Street 1:520 MARY ST STE 520
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1682
Practice Address - Country:US
Practice Address - Phone:812-424-8231
Practice Address - Fax:812-435-8794
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008053363LG0600X, 363LG0600X
INXXXXXXXXX363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300016191Medicaid
IN71008053OtherINDIANA STATE LICENSE
KY7100560290Medicaid
IN000001186463OtherANTHEM BCBS
INMM4816736OtherDEA