Individual
DESIRAE MASHELLE HYDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1300 W JEFFERSON ST, SUITE C, FRANKLIN, IN 46131-9120
(317) 736-8474
(317) 736-6040
Mailing address
1300 W JEFFERSON ST, SUITE C, FRANKLIN, IN 46131-9120
(317) 736-8474
(317) 736-6040
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71005803A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001297549
ATHEM PTAN
IN
01
—
068010535
MEDICARE PTAN
IN
05
—
201329340
—
IN
01
—
Q00551724
RAILROAD PTAN
IN
Enumeration date
10/22/2015
Last updated
08/09/2024
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