Healthcare Provider Details

I. General information

NPI: 1003620162
Provider Name (Legal Business Name): KEYANA RICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E CARMEL DR STE E300
CARMEL IN
46032-4817
US

IV. Provider business mailing address

301 E CARMEL DR STE E300
CARMEL IN
46032-4817
US

V. Phone/Fax

Practice location:
  • Phone: 317-517-7688
  • Fax:
Mailing address:
  • Phone: 317-517-7688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number220150571
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: