Provider Demographics
NPI:1154813913
Name:BRAMMER WOLF, KAYLEY MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:KAYLEY
Middle Name:MARIE
Last Name:BRAMMER WOLF
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:KAYLEY
Other - Middle Name:M
Other - Last Name:RINEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11700 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4656
Practice Address - Country:US
Practice Address - Phone:317-688-3139
Practice Address - Fax:317-688-2664
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10002455A363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001175355OtherANTHEM PTAN
IN1102431834OtherANTHEM PTAN
IN300014499Medicaid
IN000001175356OtherANTHEM PTAN