Provider Demographics
NPI:1568895811
Name:UMANA, KRISTY J (NP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:J
Last Name:UMANA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:J
Other - Last Name:BENEDICT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 W 96TH ST # 520
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12708 E 116TH ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7600
Practice Address - Country:US
Practice Address - Phone:317-415-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004542A363LF0000X, 363LF0000X
IN28102754A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201195620Medicaid
IN183380014Medicare PIN
IN201195620Medicaid