Provider Demographics
NPI:1952650673
Name:KIEFER, JULIANN KAY (PNP)
Entity Type:Individual
Prefix:MRS
First Name:JULIANN
Middle Name:KAY
Last Name:KIEFER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:JULIANN
Other - Middle Name:KAY
Other - Last Name:MARQUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1026
Mailing Address - Country:US
Mailing Address - Phone:317-777-6435
Mailing Address - Fax:317-777-6644
Practice Address - Street 1:705 RILEY HOSPITAL DR # 4340
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-944-2143
Practice Address - Fax:317-944-3107
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28234510363LP0200X
IN71006966363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1952650673Medicaid