KELLY A MANICKE (NPI# 1508015439) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508015439 |
| Entity Type | Individual |
| Full Name | KELLY A MANICKE |
| Credential | NP |
| Practice Address |
7250 Clearvista Dr Ste 355 Indianapolis IN 46256-5609 |
| Mailing Address |
6626 E 75th St Suite 500 Indianapolis IN 46250-2890 |
| Practice Telephone | 3176215676 |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2018-04-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 28164416 | IN | Nursing Service Providers |
| N | 363L00000X | Nurse Practitioner | 71002746A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
71002746A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200920210 | 05 | |
| IN | ANTHEM PROVIDER NUMBER | 000000622179 | 01 |
| IN | MEDICARE RAILROAD PTAN | P01678952 | 01 |
| IN | RAILROAD MEDICARE | P00774860 | 01 |
| Street Address |
7250 CLEARVISTA DR STE 355 |
| City | INDIANAPOLIS |
| State | IN |
| Zip Code | 46256-5609 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407942717 | Joseph A Hostetler | Physician Assistant | 7250 Clearvista Dr Ste 355, Indianapolis, IN 46256-5609 | 2006-10-05 |
| 1205450764 | Emily Brooke Thurston | Nurse Practitioner | 7250 Clearvista Dr Ste 355, Indianapolis, IN 46256-5609 | 2020-06-01 |
| 1538709308 | Tyler D Stafford | Nurse Practitioner | 7250 Clearvista Dr Ste 355, Indianapolis, IN 46256-5609 | 2020-01-09 |
| 1962049833 | Gilford Manco | Physician Assistant | 7250 Clearvista Dr Ste 355, Indianapolis, IN 46256-5609 | 2019-12-10 |
| 1396309530 | Sarah J Sampson | Physician Assistant | 7250 Clearvista Dr Ste 355, Indianapolis, IN 46256-5609 | 2019-04-23 |
| 1467015230 | Bradley T Braun | Physician Assistant | 7250 Clearvista Dr Ste 355, Indianapolis, IN 46256-5609 | 2019-04-17 |
| 1285191841 | Sarah A Thill | Physician Assistant | 7250 Clearvista Dr Ste 355, Indianapolis, IN 46256-5609 | 2019-03-01 |
| 1750857504 | Joshua J. Smith | Physician Assistant | 7250 Clearvista Dr Ste 355, Indianapolis, IN 46256-5609 | 2018-10-19 |
| 1114406196 | Hannah Hartnett | Physician Assistant | 7250 Clearvista Dr Ste 355, Indianapolis, IN 46256-5609 | 2018-08-09 |
| 1952895898 | Marissa E Ehrlich | Physician Assistant | 7250 Clearvista Dr Ste 355, Indianapolis, IN 46256-5609 | 2018-06-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790316859 | Jacob R Weeks | Behavior Technician | 9769 Crosspointed Blvd, Fishers, IN 46256 | 2020-01-28 |
| 1780236620 | Amare Hospice & Palliative Care | Family Medicine | 10475 Crosspoint Boulevard, Suite 250, Indianapolis, IN 46256 | 2019-07-11 |
| 1588226864 | Accutreat LLC | Clinical Medical Laboratory | 9661 Crosspoint Blvd, Indianapolis, IN 46256 | 2019-07-08 |
| 1447732557 | Kathleen O'hara | Marriage & Family Therapist | 8202 Clearvista Pkwy Unit 7, Indianapolis, IN 46256 | 2018-09-05 |
| 1205313608 | Healing Bridges Counseling, LLC | Marriage & Family Therapist | 8465 Keystone Crossing, Suite 266, Indianapolis, IN 46256 | 2018-07-27 |
| 1477062123 | Rosalee Ann Miller | Social Worker | 8202 Clearvista Parkway, Suite 6a, Indianapolis, IN 46256 | 2017-09-26 |
| 1760900039 | Amye Litherland | Registered Nurse | 7525 E. 82nd St Ste A, Indianapolis, IN 46256 | 2017-09-06 |
| 1275074239 | Jason Dempsey | Hearing Instrument Specialist | 8202 Clearvista Pkwy 3a, Indianapolis, IN 46256 | 2017-03-10 |
| 1578922761 | Fresenius Medical Care Indiana, LLC | Clinic/Center | 7155 Shadeland Station Way, Suite 130, Indianapolis, IN 46256 | 2016-02-16 |
| 1477925071 | Samantha Kitcoff | Physician Assistant | 8180 Clearvista Pkwy Ste 100, Indianapolis, IN 46256 | 2015-10-22 |
| Find all providers in zip 46256 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851852727 | Carmen Lagaye Bogle | Nurse Practitioner | 1050 W 72nd St, Indianapolis, IN 46260-4037 | 2019-03-25 |
| 1861991176 | Kimberly S Houchens | Nurse Practitioner | 135 N Pennsylvania St Ste 1610, Indianapolis, IN 46204-2448 | 2018-02-02 |
| 1356866834 | Andrea Elaine Tennancour | Nurse Practitioner | My Mobile Md LLC, 7007 Graham Road Suite 215, Indianapolis, IN 46220 | 2017-08-07 |
| 1194259879 | Bahtrena Rogers | Nurse Practitioner | 9302 Budd Run Dr, Indianapolis, IN 46250-1322 | 2017-04-19 |
| 1538512090 | Martita Rolanda Meeks | Nurse Practitioner | 7240 Shadeland Sta Ste 300, Indianapolis, IN 46256-3944 | 2016-07-20 |
| 1194177022 | Stephanie R Young | Nurse Practitioner | 8360 S Emerson Ave Ste 100, Indianapolis, IN 46237-8746 | 2016-07-03 |
| 1114394426 | Tamara Sue Roberts | Nurse Practitioner | 7911 N Michigan Road, Indianapolis, IN 46268-1360 | 2015-08-24 |
| 1023426780 | Lesli White | Nurse Practitioner | 1 Allison Way, Indianapolis, IN 46222-3271 | 2014-07-25 |
| 1386070274 | Kimberly Demasie | Nurse Practitioner | 7520 E 88th Pl, Suite 101, Indianapolis, IN 46256-1253 | 2013-09-24 |
| 1669788204 | Shannon L Childers-page | Nurse Practitioner | 1701 N Senate Blvd # A5231, Indianapolis, IN 46202-1239 | 2010-08-20 |
| Find all providers in INDIANAPOLIS | ||||
| City | INDIANAPOLIS |
| Zip Code | 46256 |
Please comment or provide details below to improve the information on KELLY A MANICKE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.