Provider Demographics
NPI:1770834491
Name:TODD, KRISTIN D (NP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:D
Last Name:TODD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10480 ZIONSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8745
Mailing Address - Country:US
Mailing Address - Phone:317-714-8616
Mailing Address - Fax:
Practice Address - Street 1:10480 ZIONSVILLE RD
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-8745
Practice Address - Country:US
Practice Address - Phone:317-714-8616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000281A363LA2200X
IN28100708A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health