MEDICARE: ALLYSON JUDITH STUCKEY 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	390200000X	Student in an Organized Health Care Education/Training Program		IN

General Provider Information

NPI Number	:	1679404727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYSON JUDITH STUCKEY PA-C

Provider Business Mailing Address
First Line	:	3351 COUNTY ROAD 36
Second Line	:
City	:	AUBURN
State	:	IN
Zip	:	46706-9442
Country	:	US
Telephone Number	:	260-908-2542
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 SUNSET AVE STE 250
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46208-3487
Country	:	US
Telephone Number	:	317-940-6026
Fax Number	:

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

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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