Provider Demographics
NPI:1588941108
Name:SUMMITT, CARA DIANE (NP)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:DIANE
Last Name:SUMMITT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:DIANE
Other - Last Name:HOKANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8402 HARCOURT RD STE 402
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2053
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8402 HARCOURT RD STE 402
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2053
Practice Address - Country:US
Practice Address - Phone:317-338-6563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003793A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201041380Medicaid
IN201041380Medicaid