Individual
MRS. JERICA NICHOLE BRODHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7250 CLEARVISTA DR, STE 355, INDIANAPOLIS, IN 46256-4692
(317) 621-5676
Mailing address
6626 E 75TH ST, STE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001219A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000741701
ANTHEM PIN
IN
01
—
1487680518
GROUP NPI
IN
Enumeration date
06/06/2011
Last updated
12/19/2018
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