Provider Demographics
NPI:1669183448
Name:ADRIAN-STEPHENSON, SARAH KATHLEEN (NP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KATHLEEN
Last Name:ADRIAN-STEPHENSON
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:KATHLEEN
Other - Last Name:ADRIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 RONALD REAGAN PKWY
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7085
Practice Address - Country:US
Practice Address - Phone:317-217-3000
Practice Address - Fax:317-273-5988
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013279A207QG0300X, 363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1669183448OtherANTHEM PTAN
IN300070244Medicaid