Provider Demographics
NPI:1205495686
Name:PAGE, KRISTINA (FNP - C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:FNP - C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1782
Mailing Address - Country:US
Mailing Address - Phone:463-224-2641
Mailing Address - Fax:800-783-1430
Practice Address - Street 1:300 E MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1782
Practice Address - Country:US
Practice Address - Phone:317-506-8529
Practice Address - Fax:800-783-1430
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009090A363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily