Provider Demographics
NPI:1144741687
Name:CREMONS, MOLLY KATHLEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:KATHLEEN
Last Name:CREMONS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 FLETCHER AVE APT 119
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-1040
Mailing Address - Country:US
Mailing Address - Phone:513-505-9979
Mailing Address - Fax:
Practice Address - Street 1:2451 INTELLIPLEX DR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8580
Practice Address - Country:US
Practice Address - Phone:317-392-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant