MEDICARE: KELSEY D ALLGOOD 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	10002808A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000001342723	OTHER	IN	ANTHEM PTAN
2	1102422942	OTHER	IN	ANTHEM PTAN
3	Q00403937	OTHER	IN	RAILROAD PTAN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649815945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY D ALLGOOD PA-C

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1375 N GREEN ST STE 100
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-8734
Country	:	US
Telephone Number	:	317-852-2251
Fax Number	:	317-852-1225

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

Provider Enumeration Date	:	11/10/2019
Last Update Date	:	05/07/2025

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