Provider Demographics
NPI:1457466757
Name:HEUCK, CARRIE J (NP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:J
Last Name:HEUCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:J
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9240 N MERIDIAN ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1880
Mailing Address - Country:US
Mailing Address - Phone:317-571-0030
Mailing Address - Fax:
Practice Address - Street 1:801 N STATE ST STE 305
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1270
Practice Address - Country:US
Practice Address - Phone:317-477-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2006010026363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200881870Medicaid
IN000000540116OtherANTHEM
INP01026952OtherRR MEDICARE PTAN
IN000000540116OtherANTHEM
INP01026952OtherRR MEDICARE PTAN
IN254320CMedicare PIN