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General NPI Number Information
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NPI Number | 1003057951
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Entity Type | Individual
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Provider Name | KACY YEVONNE HEAD PA
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Gender | Female
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Dates
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Enumeration Date | 03/23/2009
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Last Update Date | 05/03/2012
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Provider Practice Location Address
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Address Line | 100 HOSPITAL LN SUITE 105
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City | DANVILLE
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State | IN
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Zip | 46122-1989
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Country | US
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Telephone | 317-745-3747
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Fax | 317-745-3748
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Provider Business Mailing Address
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Address Line | 679 E COUNTY LINE RD
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City | GREENWOOD
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State | IN
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Zip | 46143-1049
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Country | US
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Telephone | 317-807-1262
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Fax | 317-859-4268
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA06217
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10001167A
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License Number State | IN
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