Provider Demographics
NPI:1518342757
Name:HENDRICKSON, ABIGAIL (PA)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:FRITCHLEY
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:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1011 MAIN ST
Practice Address - Street 2:SUITE 140
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-6977
Practice Address - Country:US
Practice Address - Phone:317-957-9000
Practice Address - Fax:317-957-9950
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN00000000A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201321060Medicaid
IN201321060Medicaid