Healthcare Provider Details

I. General information

NPI: 1164941167
Provider Name (Legal Business Name): KALEN LEIGH WILKES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N STATE ST STE 205
GREENFIELD IN
46140-1270
US

IV. Provider business mailing address

PO BOX 2005
INDIANAPOLIS IN
46206-2005
US

V. Phone/Fax

Practice location:
  • Phone: 317-325-2699
  • Fax: 317-477-6977
Mailing address:
  • Phone: 317-468-6257
  • Fax: 317-468-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10002307A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: