Individual
ALLIE MARTISSA CARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
13050 PARKSIDE DR STE 101, FISHERS, IN 46038-8247
(317) 621-2290
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71001886A
IN
363LF0000X
Family Nurse Practitioner
71001886A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200845300
—
IN
01
—
P01197278
RR MEDICARE PTAN
IN
Enumeration date
05/23/2006
Last updated
10/04/2023
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