Provider Demographics
NPI:1558041061
Name:EPIC CLINICAL PARTNERS
Entity type:Organization
Organization Name:EPIC CLINICAL PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:317-443-8172
Mailing Address - Street 1:3500 DEPAUW BLVD STE 10801
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1170
Mailing Address - Country:US
Mailing Address - Phone:317-443-8172
Mailing Address - Fax:317-203-0889
Practice Address - Street 1:3500 DEPAUW BLVD STE 10801
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1170
Practice Address - Country:US
Practice Address - Phone:317-443-8172
Practice Address - Fax:317-203-0889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2024-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty