Provider Demographics
NPI:1255647558
Name:GOOTEE, KARA A (PA)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:A
Last Name:GOOTEE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:A
Other - Last Name:RIEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8402 HARCOURT RD STE 125
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2094
Mailing Address - Country:US
Mailing Address - Phone:317-802-2000
Mailing Address - Fax:317-802-3972
Practice Address - Street 1:8402 HARCOURT RD STE 125
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2094
Practice Address - Country:US
Practice Address - Phone:317-802-2000
Practice Address - Fax:317-802-3972
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001200A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01369593Medicare PIN
IN264430033Medicare PIN
INM400023684Medicare PIN