MEDICARE: TRICIA PRYOR 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	363A00000X	Physician Assistant	10004347A	IN

General Provider Information

NPI Number	:	1205691144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRICIA PRYOR PA-C

Provider Business Mailing Address
First Line	:	4740 W ADDISON ST UNIT 1E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-6297
Country	:	US
Telephone Number	:	317-450-1064
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 PARK EAST BLVD
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-0792
Country	:	US
Telephone Number	:	765-447-4040
Fax Number	:

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

Provider Enumeration Date	:	02/20/2024
Last Update Date	:	01/26/2026

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Directions to “ TRICIA PRYOR PA-C” Practice Location

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