Provider Demographics
NPI:1356717839
Name:PUZYNSKI, KALEY B (PA-C)
Entity type:Individual
Prefix:
First Name:KALEY
Middle Name:B
Last Name:PUZYNSKI
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:KALEY
Other - Middle Name:B
Other - Last Name:BRACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 ARCADE AVE STE 200
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2485
Practice Address - Country:US
Practice Address - Phone:574-294-8404
Practice Address - Fax:574-523-1642
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601012068363A00000X
GA11953363AS0400X
FL9108931363AS0400X
IN10004160A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300086823Medicaid
FLPAT9108931OtherMEDICAL LICENSE
FLIH881ZMedicare PIN