Provider Demographics
NPI:1518069152
Name:ARNOLD, MARY BETH (RN, MSN, NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:RN, MSN, NP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:BOHNEY
Other - Suffix:
Other - Last Name Type:Former Name
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:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1402 E COUNTY LINE RD
Practice Address - Street 2:SUITE 2400
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-0963
Practice Address - Country:US
Practice Address - Phone:317-887-7880
Practice Address - Fax:317-887-7886
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000099A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01032831OtherRR MEDICARE PTAN
IN000000558347OtherANTHEM INDIANAPOLIS
IL000000591864OtherANTHEM NASHVILLE
IN677700OtherGROUP MEDICARE
IN200994840Medicaid
INP01214705OtherRR MEDICARE PTAN
IN677700OtherGROUP MEDICARE
IN000000558347OtherANTHEM INDIANAPOLIS
INQ26418Medicare UPIN
IN266180161Medicare PIN
IL000000591864OtherANTHEM NASHVILLE
INM400025689Medicare PIN