Provider Demographics
NPI:1194904557
Name:STOKES, LAUREN C (PA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:C
Last Name:STOKES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:C
Other - Last Name:CHESNUT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:6920 GATWICK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-9504
Mailing Address - Country:US
Mailing Address - Phone:317-455-1064
Mailing Address - Fax:317-455-1204
Practice Address - Street 1:6920 GATWICK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-9504
Practice Address - Country:US
Practice Address - Phone:317-455-1064
Practice Address - Fax:317-455-1204
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001077A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant