Provider Demographics
NPI:1336336528
Name:SHORT-YODER, TRICIA J (NP)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:J
Last Name:SHORT-YODER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:J
Other - Last Name:SHORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6626 E 75TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7979 N SHADELAND AVE
Practice Address - Street 2:STE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2042
Practice Address - Country:US
Practice Address - Phone:317-621-4300
Practice Address - Fax:317-621-4301
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002468A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01777172OtherMEDICARE RR
IN413960OtherWELLCARE
IN200871850Medicaid
IN000000537741OtherANTHEM
INP00817391OtherMEDICARE RR
IN256170EMedicare PIN
INP01777172OtherMEDICARE RR
IN413960OtherWELLCARE