Provider Demographics
NPI:1457456659
Name:SKELTON, ALTA M (NP)
Entity Type:Individual
Prefix:MRS
First Name:ALTA
Middle Name:M
Last Name:SKELTON
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 1:755 W CARMEL DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5877
Mailing Address - Country:US
Mailing Address - Phone:317-810-1399
Mailing Address - Fax:317-810-1391
Practice Address - Street 1:755 W CARMEL DR
Practice Address - Street 2:SUITE 150
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5877
Practice Address - Country:US
Practice Address - Phone:317-810-1399
Practice Address - Fax:317-810-1391
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28119508A163W00000X
IN71001461A363L00000X
IN71001461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000298150OtherANTHEM PROVIDER NUMBER
IN000000298150OtherUNICARE PROVIDER NUMBER
IN366735000OtherUS DEPT. OF LABOR
IN366735000OtherUS DEPT. OF LABOR
INP00018519Medicare ID - Type UnspecifiedMEDICARE RAILROAD
IN000000298150OtherUNICARE PROVIDER NUMBER