Individual
KACY YEVONNE HEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
100 HOSPITAL LN, SUITE 105, DANVILLE, IN 46122-1989
(317) 745-3747
(317) 745-3748
Mailing address
679 E COUNTY LINE RD, GREENWOOD, IN 46143-1049
(317) 807-1262
(317) 859-4268
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001167A
IN
363A00000X
Physician Assistant
PA06217
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000736707
ANTHEM PIN
IN
01
—
1487680518
GROUP NPI
IN
05
—
202786401
—
TX
01
—
800N55
BCBS
TX
Enumeration date
03/23/2009
Last updated
05/03/2012
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