Provider Demographics
NPI:1114476611
Name:EICKHOFF, KARISSA (PA-C)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:EICKHOFF
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:740 W GREEN MEADOWS DR STE 110
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-3098
Practice Address - Country:US
Practice Address - Phone:317-318-7030
Practice Address - Fax:317-318-7045
Is Sole Proprietor?:No
Enumeration Date:2016-09-25
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9115876363A00000X
IN10002164A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300006011Medicaid