Provider Demographics
NPI:1437648755
Name:MEDLER, KRISIE L (AGACNP)
Entity type:Individual
Prefix:MRS
First Name:KRISIE
Middle Name:L
Last Name:MEDLER
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:KRISIE
Other - Middle Name:L
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 W COLUMBIA ST STE 420
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1782
Mailing Address - Country:US
Mailing Address - Phone:812-422-3254
Mailing Address - Fax:812-426-6388
Practice Address - Street 1:600 MARY ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1658
Practice Address - Country:US
Practice Address - Phone:812-422-3254
Practice Address - Fax:812-426-6388
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4021981363LA2100X
IN71008053A363LA2100X
IN71008053363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100560290Medicaid
IN71008053OtherINDIANA STATE LICENSE
IN000001186463OtherANTHEM BCBS
IN300016191Medicaid
INMM4816736OtherDEA