Individual
ALLYSON ANNE FARMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2651 E DISCOVERY PKWY, BLOOMINGTON, IN 47408-9059
(812) 918-3400
(812) 332-7265
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002512A
IN
363A00000X
Physician Assistant
3569
SC
363AM0700X
Medical Physician Assistant
10002512A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090540866
MEDICARE PTAN
IN
05
—
4429PA
—
SC
Enumeration date
07/10/2018
Last updated
09/09/2023
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