Provider Demographics
NPI:1760569065
Name:CARMIN, SHANA KAYE (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:KAYE
Last Name:CARMIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:KAYE
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
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:765-298-5280
Mailing Address - Fax:765-724-3386
Practice Address - Street 1:2116 S PARK AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:IN
Practice Address - Zip Code:46001-8048
Practice Address - Country:US
Practice Address - Phone:765-724-4455
Practice Address - Fax:765-724-6247
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28133612A363LF0000X
IN71002280A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01157311OtherMEDICARE RR
IN000000507640OtherANTHEM
IN200846070BMedicaid
IN200846070BMedicaid