Healthcare Provider Details

I. General information

NPI: 1962791731
Provider Name (Legal Business Name): CAMRA BETH HUSSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 E WASHINGTON ST STE 200
INDIANAPOLIS IN
46219-5563
US

IV. Provider business mailing address

6737 MOSS CREEK PL
INDIANAPOLIS IN
46237-2878
US

V. Phone/Fax

Practice location:
  • Phone: 317-355-7171
  • Fax:
Mailing address:
  • Phone: 317-364-9320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11015985A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: