Provider Demographics
NPI:1982128575
Name:TODD, CAROLINE WISE
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:WISE
Last Name:TODD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-1926
Mailing Address - Country:US
Mailing Address - Phone:859-866-6031
Mailing Address - Fax:
Practice Address - Street 1:375 THOMAS MORE PKWY STE 209
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-2175
Practice Address - Country:US
Practice Address - Phone:859-866-6031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant