MEDICARE: CARLA WIMS

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1487189643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA WIMS

Provider Business Mailing Address
First Line	:	8149 E AVERY DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-1721
Country	:	US
Telephone Number	:	317-223-8544
Fax Number	:

Provider Business Practice Location Address
First Line	:	8202 CLEARVISTA PKWY STE 6A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-1442
Country	:	US
Telephone Number	:	317-588-6538
Fax Number	:

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

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	04/25/2017

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Directions to “ CARLA WIMS ” Practice Location

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