Individual
KRISTY MARDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
11725 ILLINOIS ST STE 558, CARMEL, IN 46032-3009
(317) 688-5500
Mailing address
11725 ILLINOIS ST STE 558, CARMEL, IN 46032-3009
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71009931A
IN
363LF0000X
Family Nurse Practitioner
Primary
71009931A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001469765
ANTHEM PTAN
IN
01
—
1102558010
ANTHEM PTAN
IN
05
—
300037665
—
IN
Enumeration date
03/30/2020
Last updated
02/13/2025
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