Individual
KELLY NICOLE WIKSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8501 HARCOURT RD, INDIANAPOLIS, IN 46260-2046
(317) 875-9105
(317) 808-8802
Mailing address
8501 HARCOURT RD, INDIANAPOLIS, IN 46260-2046
(317) 875-9105
(317) 808-8802
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000393A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10000393A
IN LICENSE
IN
05
—
300016127
—
IN
Enumeration date
08/12/2006
Last updated
07/15/2025
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