Provider Demographics
NPI:1477860997
Name:CLYNE, KRISTIN JEAN (ANP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JEAN
Last Name:CLYNE
Suffix:
Gender:
Credentials:ANP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 W 96TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1172
Mailing Address - Country:US
Mailing Address - Phone:317-876-3699
Mailing Address - Fax:317-876-3600
Practice Address - Street 1:1311 W 96TH ST STE 110
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1172
Practice Address - Country:US
Practice Address - Phone:317-876-3699
Practice Address - Fax:317-876-3600
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003352A363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400028448Medicare PIN