MEDICARE: MR. NATHANIEL PAUL ACREE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	36002817A	IN
2	363A00000X	Physician Assistant	10004771A	IN

General Provider Information

NPI Number	:	1013453927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NATHANIEL PAUL ACREE PA-C

Provider Business Mailing Address
First Line	:	8450 NORTHWEST BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-1381
Country	:	US
Telephone Number	:	317-802-2000
Fax Number	:	317-802-2170

Provider Business Practice Location Address
First Line	:	2548 CUMBERLAND AVE STE 100
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-4083
Country	:	US
Telephone Number	:	765-447-4165
Fax Number	:	765-446-5317

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2017
Last Update Date	:	06/26/2026

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