Provider Demographics
NPI:1649815945
Name:ALLGOOD, KELSEY D (PA-C)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:D
Last Name:ALLGOOD
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:D
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1375 N GREEN ST STE 100
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-8734
Practice Address - Country:US
Practice Address - Phone:317-852-2251
Practice Address - Fax:317-852-1225
Is Sole Proprietor?:No
Enumeration Date:2019-11-10
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10002808A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001342723OtherANTHEM PTAN
IN1102422942OtherANTHEM PTAN
INQ00403937OtherRAILROAD PTAN
IN300033749Medicaid