Provider Demographics
NPI:1992056774
Name:KESLER, SHANE W (RPA-C)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:W
Last Name:KESLER
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7151 MARSH RD STE 150
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1631
Mailing Address - Country:US
Mailing Address - Phone:317-208-3866
Mailing Address - Fax:317-208-3867
Practice Address - Street 1:7151 MARSH RD STE 150
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1631
Practice Address - Country:US
Practice Address - Phone:317-208-3866
Practice Address - Fax:317-208-3867
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004441363A00000X
IN10001547A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN062110013OtherMEDICARE PTAN