Healthcare Provider Details

I. General information

NPI: 1013453927
Provider Name (Legal Business Name): NATHANIEL PAUL ACREE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2548 CUMBERLAND AVE STE 100
WEST LAFAYETTE IN
47906-4083
US

IV. Provider business mailing address

8450 NORTHWEST BLVD
INDIANAPOLIS IN
46278-1381
US

V. Phone/Fax

Practice location:
  • Phone: 765-447-4165
  • Fax: 765-446-5317
Mailing address:
  • Phone: 317-802-2000
  • Fax: 317-802-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36002817A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10004771A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: