Provider Demographics
NPI:1922838358
Name:RICCI, KRISTINE ALICE (NP)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ALICE
Last Name:RICCI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:ALICE
Other - Last Name:RISHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 N SENATE BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1228
Practice Address - Country:US
Practice Address - Phone:317-962-2515
Practice Address - Fax:317-962-2500
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015646A363LF0000X
NC2023194370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1104430628OtherANTHEM PTAN
IN300097631Medicaid