Individual
KYLIE TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
550 UNIVERSITY BLVD, INDIANAPOLIS, IN 46202-5149
(317) 948-3226
Mailing address
550 UNIVERSITY BLVD, INDIANAPOLIS, IN 46202-5149
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10003424A
IN
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300056643
—
IN
Enumeration date
06/10/2021
Last updated
12/30/2025
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