Individual
MISS KAILEY DIANN VERNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7165 CLEARVISTA WAY, INDIANAPOLIS, IN 46256-4621
(317) 621-5100
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PENDING
IN
363AM0700X
Medical Physician Assistant
Primary
363AM0700X
IN
Other
Enumeration date
07/10/2020
Last updated
11/04/2020
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