Provider Demographics
NPI:1972099497
Name:PRICE, SERINA
Entity type:Individual
Prefix:
First Name:SERINA
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SERINA
Other - Middle Name:
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8333 NAAB RD STE 301
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1983
Mailing Address - Country:US
Mailing Address - Phone:317-338-9355
Mailing Address - Fax:
Practice Address - Street 1:1765 E LINCOLN RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3993
Practice Address - Country:US
Practice Address - Phone:765-236-8380
Practice Address - Fax:765-236-8381
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28185024A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics