Basic Information
| Provider Information | |||||||||
| NPI: | 1235572124 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOUNT | ||||||||
| FirstName: | KRISTY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD/PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 SOUTHFIELD DR STE 1310 | ||||||||
| Address2: | |||||||||
| City: | PLAINFIELD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461684499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178397741 | ||||||||
| FaxNumber: | 3178397749 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 SOUTHFIELD DR STE 1310 | ||||||||
| Address2: | |||||||||
| City: | PLAINFIELD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461684499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178397741 | ||||||||
| FaxNumber: | 3178397749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2013 | ||||||||
| LastUpdateDate: | 03/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 11017416A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 01074340A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.