Individual provider Active NPI

Kimberly L Poole, FNP-C

  • Family Nurse Practitioner
  • Indianapolis, IN
National Provider Identifier
1336641646
Registry record updated Apr 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71009540A Issued in IN
Practice address
6020 Crawfordsville Rd Ste 102
Indianapolis, IN 46224-3710
Phone
(317) 957-2070
Fax
(317) 957-2560
NPI assigned
Mar 2, 2018
Last updated
Apr 2, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71009540A IN Primary
Pediatric Registered Nurse 163WP0200X 28191368A IN

Addresses

Primary practice location

6020 Crawfordsville Rd Ste 102
Indianapolis, IN 46224-3710

Mailing address

3403 E Raymond Street
Indianapolis, IN 46203-4744
Phone (317) 957-2000

Other identifiers 1

IdentifierTypeStateIssuer
300032899MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240717002621 IN Practitioner - Nurse Practitioner 6002351749 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
May accept Medicare assignment
Group practices
Healthnet IncGroup PAC ID 7214840933, 77 clinicians

Practice addresses (Care Compare)

2855 N Keystone Ave
Suite 120
Indianapolis, IN 46218-2790

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
28191368AINMDPediatric Registered Nurse
71009540AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Healthnet, Inc. CurrentSince Jul 10, 2024 Accepting new patients

Locations

1500 E Michigan St
Indianapolis, IN 46201
Phone (317) 340-0323

1701 Senate Blvd
Indianapolis, IN 46202
Phone (317) 612-2754

1801 Senate Blvd
Ste 310
Indianapolis, IN 46202
Phone (317) 957-2070

2340 E 10th St
Indianapolis, IN 46201
Phone (317) 633-7360

2855 N Keystone Ave
Ste 130
Indianapolis, IN 46218

3401 E Raymond St
#0
Indianapolis, IN 46203

3403 E Raymond St
Indianapolis, IN 46203
Phone (317) 957-2000

6020 Crawfordsville Rd
Ste 102
Speedway, IN 46224
Phone (317) 957-2070

Interoperability endpoints

  • Direct secure messaging: kimberly.poole@hn.eclinicaldirectplus.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1519948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743552000000",
    "number": "1336641646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3403 E RAYMOND STREET",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462034744",
            "telephone_number": "317-957-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6020 CRAWFORDSVILLE RD STE 102",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462243710",
            "telephone_number": "317-957-2070",
            "fax_number": "317-957-2560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POOLE",
        "first_name": "KIMBERLY",
        "middle_name": "L",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-02",
        "last_updated": "2025-04-02",
        "certification_date": "2025-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71009540A",
            "primary": true
        },
        {
            "code": "163WP0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pediatrics",
            "state": "IN",
            "license": "28191368A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300032899",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.