Individual
KELLEY C SUMMERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7250 CLEARVISTA DR STE 355, INDIANAPOLIS, IN 46256
(317) 621-5676
(317) 621-5678
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-7588
(317) 957-2749
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002484A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300016659
—
IN
01
—
P02085726
RAIDROAD MEDICARE
IN
Enumeration date
05/15/2018
Last updated
10/31/2018
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