MEDICARE: DAPHNEY KAY LEVERETT N.P.

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	363LF0000X	Family Nurse Practitioner	71001239A	IN

General Provider Information

NPI Number	:	1346246691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAPHNEY KAY LEVERETT N.P.

Provider Business Mailing Address
First Line	:	3850 SHORE DR
Second Line	:	SUITE 203
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-5621
Country	:	US
Telephone Number	:	317-297-3774
Fax Number	:	317-298-8301

Provider Business Practice Location Address
First Line	:	3850 SHORE DR
Second Line	:	SUITE 203
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-5621
Country	:	US
Telephone Number	:	317-297-3774
Fax Number	:	317-298-8301

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	11/16/2007

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