Individual
MACKENZIE T YEARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11645 ILLINOIS ST, CARMEL, IN 46032-3320
(317) 944-0920
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003937A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264430H16
MEDICARE PTAN
IN
05
—
300072273
—
IN
Enumeration date
02/17/2023
Last updated
06/08/2023
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