Healthcare Provider Details

I. General information

NPI: 1417838608
Provider Name (Legal Business Name): MOUSSA KABA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MRS. GOSSA KABA

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14134 CALMING WATERS
FISHERS IN
46038-6659
US

IV. Provider business mailing address

14134 CALMING WATERS
FISHERS IN
46038-6659
US

V. Phone/Fax

Practice location:
  • Phone: 317-900-6355
  • Fax:
Mailing address:
  • Phone: 317-900-6355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number25-018408-1
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number25-018408-1
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: