Healthcare Provider Details

I. General information

NPI: 1518802230
Provider Name (Legal Business Name): LAURYN MICHELLE FARNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 S MAIN ST
UPLAND IN
46989-9257
US

IV. Provider business mailing address

PO BOX 31
SHIPSHEWANA IN
46565-0031
US

V. Phone/Fax

Practice location:
  • Phone: 765-770-0650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10005351A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: