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General NPI Number Information
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NPI Number | 1043558596
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Entity Type | Individual
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Provider Name | KELLY L FOUTCH PA
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Gender | Female
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Dates
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Enumeration Date | 01/17/2013
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 489 S STATE ROAD 135 STE F
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City | GREENWOOD
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State | IN
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Zip | 46142-1407
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Country | US
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Telephone | 317-887-7640
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Fax |
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Provider Business Mailing Address
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Address Line | 6626 E 75TH ST STE 500
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2890
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Country | US
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Telephone |
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10001285A
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License Number State | IN
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