Individual
KIMBERLY K LOCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
13420 N MERIDIAN ST STE 300, CARMEL, IN 46032-1581
(317) 582-8300
Mailing address
13420 N MERIDIAN ST STE 300, CARMEL, IN 46032-1581
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003524A
IN
363AM0700X
Medical Physician Assistant
10003524A
IN
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102638463
ANTHEM PTAN
IN
05
—
300067806
—
IN
Enumeration date
08/03/2022
Last updated
04/29/2025
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