Healthcare Provider Details

I. General information

NPI: 1780597047
Provider Name (Legal Business Name): NOELLE ALEXANDRIA KENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11502 LONG LAKE DR
INDIANAPOLIS IN
46235-6856
US

IV. Provider business mailing address

11502 LONG LAKE DR
INDIANAPOLIS IN
46235-6856
US

V. Phone/Fax

Practice location:
  • Phone: 260-804-2665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: