Provider Demographics
NPI:1942615661
Name:PATRICK, KAYCIE (NP)
Entity Type:Individual
Prefix:
First Name:KAYCIE
Middle Name:
Last Name:PATRICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MAIN ST
Mailing Address - Street 2:STE 308
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-1559
Mailing Address - Country:US
Mailing Address - Phone:765-644-0500
Mailing Address - Fax:765-644-0510
Practice Address - Street 1:2200 FOREST RIDGE PKWY STE 240
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-2943
Practice Address - Country:US
Practice Address - Phone:765-521-7385
Practice Address - Fax:765-521-7394
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009078A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily