=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447052899
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAMIYA QUARLES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2025
-----------------------------------------------------
Last Update Date | 03/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10030 E WASHINGTON ST STE 150
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46229-2656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-991-2508
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10030 E WASHINGTON ST STE 150
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46229-2656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-991-2508
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 247ZC0005X
-----------------------------------------------------
Taxonomy Name | Clinical Laboratory Director (Non-physician)
-----------------------------------------------------
License Number | B3R4M8K9
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------