Trista Michelle Anderson, NP
Individual provider Active NPI Nurse Practitioner · Indianapolis, IN
NPI 1689934895 · NPPES record last updated Apr 8, 2015
Key facts
- NPI
- 1689934895
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 71004062A (IN)
- Practice address
- 1550 E. County Line Road
Suite 300
Indianapolis, IN 46227-0990 - Phone
- (317) 497-2300
- NPI assigned
- May 22, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71004062A | IN | MD | Nurse Practitioner |
| 28168862A | IN | MD | Women's Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Women's Health Nurse Practitioner | 363LW0102X | 28168862A | IN | |
| Nurse Practitioner | 363L00000X | 71004062A | IN | Yes |
Addresses
Primary practice location
1550 E. County Line Road
Suite 300
Indianapolis, IN 46227-0990
Mailing address
6626 E 75TH St
500
Indianapolis, IN 46250-2805
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P01316451 | Other | IN | MEDICARE RR PTAN |
| 201082150 | Medicaid | IN |
Other providers in Indianapolis, IN
- Ryan David Anderson
- Sierra Anderson
- Sophia Renee Anderson
- Taletha Anderson
- Tomeika Rashel Anderson
- Victoria A Anderson
- Wesley Luke Anderson
- Whitney Anderson
- Leah Christine Anderton
- Theresa Andis
All providers in Indianapolis, IN · Nurse Practitioner in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.