Provider Demographics
NPI:1497990600
Name:CRIPE, MYLINDA JORAE (NP-C)
Entity Type:Individual
Prefix:
First Name:MYLINDA
Middle Name:JORAE
Last Name:CRIPE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-621-3684
Mailing Address - Fax:317-621-3689
Practice Address - Street 1:1095 BROAD RIPPLE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2034
Practice Address - Country:US
Practice Address - Phone:317-621-3680
Practice Address - Fax:317-621-3689
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002799A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01291550OtherRAILROAD MEDICARE
IN000000594941OtherANTHEM
IN200931610Medicaid
INP01291550OtherRAILROAD MEDICARE
IN214960CMedicare PIN