Provider Demographics
NPI:1669276150
Name:CARSON, PHEBE A
Entity type:Individual
Prefix:
First Name:PHEBE
Middle Name:A
Last Name:CARSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7565 BAYVIEW CLUB DR APT 1B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2390
Mailing Address - Country:US
Mailing Address - Phone:463-267-9626
Mailing Address - Fax:
Practice Address - Street 1:7565 BAYVIEW CLUB DR APT 1B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2390
Practice Address - Country:US
Practice Address - Phone:463-267-9626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23-015820251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health