Individual
MIRANDA ALLYSSA GIDDENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2400 17TH ST, COLUMBUS, IN 47201-5351
(812) 376-5974
Mailing address
PO BOX 775383, CHICAGO, IL 60677-5383
(812) 376-5315
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10004954A
IN
Other
Enumeration date
08/22/2025
Last updated
09/29/2025
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