Provider Demographics
NPI:1619485786
Name:KIRISITS, TERESA E (FNP-C)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:E
Last Name:KIRISITS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:E
Other - Last Name:FOUTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6983 HILLSDALE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2054
Mailing Address - Country:US
Mailing Address - Phone:317-849-8350
Mailing Address - Fax:317-576-6311
Practice Address - Street 1:2330 S DIXON RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6411
Practice Address - Country:US
Practice Address - Phone:765-455-8822
Practice Address - Fax:765-865-3935
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28209519A163W00000X
IN71007794A363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300011704Medicaid