Provider Demographics
NPI:1760502769
Name:HESSION, MARY PATRICIA (CNS,APRN, BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:HESSION
Suffix:
Gender:F
Credentials:CNS,APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 ANSAR LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-3126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3307 W 96TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1106
Practice Address - Country:US
Practice Address - Phone:317-876-3699
Practice Address - Fax:317-876-3600
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000180A364SP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28070396AOtherRN NUMBER
IN70000180AOtherSTATE CNS NUMBER
IN70000180BOtherSTATE NARCOTIC IDENTIFIER
IN200526930Medicaid
IN200526930Medicaid
IN200526930Medicaid
IN215620DMedicare PIN