Individual
DEA JOANNE KENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
9894 E 121ST ST, FISHERS, IN 46037
(317) 621-6060
(317) 355-6965
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
71002204A
IN
363LA2200X
Adult Health Nurse Practitioner
Primary
71002204A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000577583
ANTHEM PROVIDER NUMBER
IN
01
—
000000603906
ANTHEM
IN
05
—
200908120
—
IN
01
—
P01347717
MEDICARE RR PTAN
IN
Enumeration date
01/16/2007
Last updated
06/18/2018
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