Provider Demographics
NPI:1003620162
Name:RICE, KEYANA
Entity type:Individual
Prefix:
First Name:KEYANA
Middle Name:
Last Name:RICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E CARMEL DR STE E300
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4817
Mailing Address - Country:US
Mailing Address - Phone:317-517-7688
Mailing Address - Fax:
Practice Address - Street 1:301 E CARMEL DR STE E300
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4817
Practice Address - Country:US
Practice Address - Phone:317-517-7688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN220150571172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty