Provider Demographics
NPI:1649963364
Name:BONEBRAKE, KRISH LYNNE (FNP-C)
Entity type:Individual
Prefix:
First Name:KRISH
Middle Name:LYNNE
Last Name:BONEBRAKE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11530 ALLISONVILLE RD STE 155
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1862
Mailing Address - Country:US
Mailing Address - Phone:317-739-4243
Mailing Address - Fax:
Practice Address - Street 1:11530 ALLISONVILLE RD STE 155
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1862
Practice Address - Country:US
Practice Address - Phone:317-739-4243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013921A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily