Individual
KELSEY S WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1111 RONALD REAGAN PKWY, B1321, AVON, IN 46123-7085
(317) 217-3300
(317) 217-3474
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002139A
IN
363AM0700X
Medical Physician Assistant
10002139A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068010336
MEDICARE PTAN
IN
01
—
264430B03
MEDICARE PTAN
IN
01
—
267030268
MEDICARE PTAN
IN
05
—
300013802
—
IN
01
—
P02386895
RAILROAD PTAN
IN
Enumeration date
10/17/2016
Last updated
02/19/2025
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