Provider Demographics
NPI:1760534432
Name:KENT, DEA JOANNE (NP-C)
Entity Type:Individual
Prefix:
First Name:DEA
Middle Name:JOANNE
Last Name:KENT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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 1:9894 E 121ST ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037
Practice Address - Country:US
Practice Address - Phone:317-621-6060
Practice Address - Fax:317-355-6965
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002204A363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000577583OtherANTHEM PROVIDER NUMBER
IN000000603906OtherANTHEM
INP01347717OtherMEDICARE RR PTAN
IN200908120Medicaid
INP01347717OtherMEDICARE RR PTAN
IN266180347Medicare PIN
IN815490EEEEMedicare PIN
IN000000577583OtherANTHEM PROVIDER NUMBER