Provider Demographics
NPI:1982206694
Name:BABB, KAYLEIGH ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:ANN
Last Name:BABB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 GRAY SQUIRREL DR
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-9168
Mailing Address - Country:US
Mailing Address - Phone:765-425-7857
Mailing Address - Fax:
Practice Address - Street 1:1450 E 20TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46218-3454
Practice Address - Country:US
Practice Address - Phone:317-653-1990
Practice Address - Fax:317-653-1999
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10003114A363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant