Provider Demographics
NPI:1386070274
Name:DEMASIE, KIMBERLY (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:DEMASIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-8536
Mailing Address - Country:US
Mailing Address - Phone:317-506-2954
Mailing Address - Fax:
Practice Address - Street 1:7520 E 88TH PL
Practice Address - Street 2:SUITE 101
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1253
Practice Address - Country:US
Practice Address - Phone:317-735-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28131686A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health