Provider Demographics
NPI:1508176892
Name:ALCALA, AUDREY R (FNP)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:R
Last Name:ALCALA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:R
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:765-298-5280
Mailing Address - Fax:765-552-3351
Practice Address - Street 1:1515 S 19TH ST
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-2941
Practice Address - Country:US
Practice Address - Phone:765-298-2800
Practice Address - Fax:765-298-2820
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003418A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200999630Medicaid
INP01213055OtherRR MEDICARE PTAN
INP01213055OtherRR MEDICARE PTAN