Individual
CASEY ANN BAGWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1481 W 10TH ST, INDIANAPOLIS, IN 46202-2803
(317) 554-0000
Mailing address
1481 W 10TH ST, INDIANAPOLIS, IN 46202-2803
(317) 554-0000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28229324A
IN
363LF0000X
Family Nurse Practitioner
Primary
71013604A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1103099083
ANTHEM
IN
05
—
300075058
—
IN
Enumeration date
07/06/2022
Last updated
04/29/2026
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