Individual
KELLEY L WORMMEESTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
714 N SENATE AVE STE 100, INDIANAPOLIS, IN 46202-3297
(317) 715-6402
(317) 715-6415
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10002773A
IN
Other
Enumeration date
09/05/2019
Last updated
02/24/2021
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