Provider Demographics
NPI:1205691144
Name:PRYOR, TRICIA (PA-C)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:PRYOR
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 1:19169 PRAIRIE CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-6648
Mailing Address - Country:US
Mailing Address - Phone:317-450-1064
Mailing Address - Fax:
Practice Address - Street 1:950 PARK EAST BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-0792
Practice Address - Country:US
Practice Address - Phone:765-447-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10004347A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant