Provider Demographics
NPI:1053584276
Name:POE, CHRISTINE NICOLE (ARNP)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:NICOLE
Last Name:POE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W CARMEL DR STE 103
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8707
Mailing Address - Country:US
Mailing Address - Phone:317-709-0706
Mailing Address - Fax:888-505-6818
Practice Address - Street 1:1200 W CARMEL DR STE 103
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8707
Practice Address - Country:US
Practice Address - Phone:317-709-0706
Practice Address - Fax:888-505-6818
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001075A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200939430Medicaid