Provider Demographics
NPI:1902070089
Name:TEKULVE, KRISTYN J (MD)
Entity type:Individual
Prefix:
First Name:KRISTYN
Middle Name:J
Last Name:TEKULVE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6983 HILLSDALE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2054
Mailing Address - Country:US
Mailing Address - Phone:317-849-5350
Mailing Address - Fax:317-576-6311
Practice Address - Street 1:2330 S DIXON RD STE 325
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6430
Practice Address - Country:US
Practice Address - Phone:765-455-8822
Practice Address - Fax:765-865-3935
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01069780A2084N0400X, 2084N0402X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201108530Medicaid