Individual
KAYLIE NICOLE PRICHODKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1629 MEDICAL ARTS BLVD STE 200, ANDERSON, IN 46011-3454
(765) 298-5439
(765) 298-4920
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085006233
IL
363A00000X
Physician Assistant
Primary
10001876A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01512454
MEDICARE RAILROAD PTAN
IN
Enumeration date
04/24/2015
Last updated
09/13/2023
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