Provider Demographics
NPI:1881484962
Name:WAKEFIELD, ISREAL KIRK HUNTER SR (PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:ISREAL KIRK
Middle Name:HUNTER
Last Name:WAKEFIELD
Suffix:SR
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 WATER OAK WAY
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7439
Mailing Address - Country:US
Mailing Address - Phone:317-838-5693
Mailing Address - Fax:
Practice Address - Street 1:1777 WATER OAK WAY
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7439
Practice Address - Country:US
Practice Address - Phone:317-838-5693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28193439A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health