Provider Demographics
NPI:1699719005
Name:DAVIS SKAGGS, KRISTEN (MD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:DAVIS SKAGGS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1375 N GREEN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-8705
Practice Address - Country:US
Practice Address - Phone:317-852-2251
Practice Address - Fax:317-852-1225
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055741A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200380580Medicaid
IN200380580Medicaid
INP00868387Medicare PIN
IN345630IMedicare PIN