Provider Demographics
NPI:1790044055
Name:TEETER, KAM E (NP)
Entity Type:Individual
Prefix:
First Name:KAM
Middle Name:E
Last Name:TEETER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KAM
Other - Middle Name:E
Other - Last Name:BISEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7440 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1720
Mailing Address - Country:US
Mailing Address - Phone:260-467-9358
Mailing Address - Fax:844-235-9901
Practice Address - Street 1:7440 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1720
Practice Address - Country:US
Practice Address - Phone:260-467-9358
Practice Address - Fax:844-235-9901
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28183005A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201081570Medicaid