Healthcare Provider Details

I. General information

NPI: 1902633795
Provider Name (Legal Business Name): KEYLA MATTHEWS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 WESTFIELD BLVD
CARMEL IN
46280-1249
US

IV. Provider business mailing address

11011 WESTFIELD BLVD
CARMEL IN
46280-1249
US

V. Phone/Fax

Practice location:
  • Phone: 317-690-1799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number71015719A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: