Provider Demographics
NPI:1316241524
Name:JULIAN, KELSEY MARIE (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:MARIE
Last Name:JULIAN
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:MARIE
Other - Last Name:DAILY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPAS, PA-C
Mailing Address - Street 1:1550 E COUNTY LINE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-0990
Mailing Address - Country:US
Mailing Address - Phone:317-497-6497
Mailing Address - Fax:317-497-6400
Practice Address - Street 1:1550 E COUNTY LINE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-0990
Practice Address - Country:US
Practice Address - Phone:317-497-6497
Practice Address - Fax:317-497-6400
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001232A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000719440OtherANTHEM
IN9793702OtherAETNA
IN000000719440OtherANTHEM
INM400048172Medicare PIN