Provider Demographics
NPI:1477860997
Name:CLYNE, KRISTIN JEAN (NP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JEAN
Last Name:CLYNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1801 N SENATE BLVD
Mailing Address - Street 2:MPC-2 SUITE 3100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1228
Mailing Address - Country:US
Mailing Address - Phone:317-962-9712
Mailing Address - Fax:317-962-9704
Practice Address - Street 1:1801 N SENATE BLVD
Practice Address - Street 2:MPC-2 SUITE 3100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1228
Practice Address - Country:US
Practice Address - Phone:317-962-9712
Practice Address - Fax:317-962-9704
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003352A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400028448Medicare PIN