Provider Demographics
NPI:1417998139
Name:WESTBERRY, JOEL C (PA)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:C
Last Name:WESTBERRY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4880 CENTURY PLAZA RD
Practice Address - Street 2:STE 265
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5471
Practice Address - Country:US
Practice Address - Phone:317-216-2700
Practice Address - Fax:317-216-2777
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000109363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN970005516OtherRR MEDICARE PTAN
IN970005516OtherRR MEDICARE PTAN
INP01141666Medicare PIN
IN676050VMedicare PIN
INS48066Medicare UPIN