Provider Demographics
NPI:1053307397
Name:CLARY, KARIN J (PA)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:J
Last Name:CLARY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KARIN
Other - Middle Name:J
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:12772 HAMILTON CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5422
Mailing Address - Country:US
Mailing Address - Phone:317-814-1000
Mailing Address - Fax:317-814-1015
Practice Address - Street 1:12772 HAMILTON CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5422
Practice Address - Country:US
Practice Address - Phone:317-814-1000
Practice Address - Fax:317-814-1015
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000461A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10000461AOtherPHYSICIAN ASSISTANT CERTI