Healthcare Provider Details

I. General information

NPI: 1356717839
Provider Name (Legal Business Name): KALEY B PUZYNSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KALEY B BRACY

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ARCADE AVE STE 200
ELKHART IN
46514-2485
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 574-294-8404
  • Fax: 574-523-1642
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601012068
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number11953
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number9108931
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10004160A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: