MEDICARE: HAILEY KNECHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant	10003489A	IN

General Provider Information

NPI Number	:	1487327797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILEY KNECHT

Provider Business Mailing Address
First Line	:	312 E LOUISIANA ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-3811
Country	:	US
Telephone Number	:	317-726-7147
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 E LOUISIANA ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-3811
Country	:	US
Telephone Number	:	317-726-7147
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2021
Last Update Date	:	12/31/2024

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Directions to “ HAILEY KNECHT ” Practice Location

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