KELSEY WIDEMAN


Address: 714 N Michigan St, South Bend, IN 46601
Phone: 5746477477

KELSEY WIDEMAN (NPI# 1124495650) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1124495650
Entity Type Individual
Full Name KELSEY WIDEMAN
Credential PA-C
Practice Address 714 N Michigan St
South Bend
IN 46601
Mailing Address 710 N Niles Ave
South Bend
IN 46617-1924
Practice Telephone 5746477477
Practice Fax Number 5746473655
Mailing Telephone 5746471610
Mailing Fax Number 5742376069
Enumeration Date 2015-09-01
Last Update Date 2019-01-10
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363AM0700X Physician Assistant
Specialization: Medical
10001856A IN Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
IN 300006438 05

Provider Secondary Practice Location

Address Telephone Number Fax Number
5215 Holy Cross Parkway, Mishawaka, IN 465451469 5745233160

Office Location

Street Address 714 N MICHIGAN ST
City SOUTH BEND
State IN
Zip Code 46601

Providers in the same location

NPI Name Taxonomy Address Enumeration
1033115852 Dale Alan Patterson Family Medicine 714 N Michigan St, South Bend, IN 46601-1035 2005-06-27
1457972499 Megan Susanne Spencer Student in an Organized Health Care Education/Training Program 714 N Michigan St, South Bend, IN 46601-1035 2020-04-30
1588284079 Madeline Grace Chandler Student in an Organized Health Care Education/Training Program 714 N Michigan St, South Bend, IN 46601-1035 2020-04-24
1255951968 Kallie Kram Student in an Organized Health Care Education/Training Program 714 N Michigan St, South Bend, IN 46601-1035 2020-04-22
1235759069 Audrieanna Marie Kramer Student in an Organized Health Care Education/Training Program 714 N Michigan St, South Bend, IN 46601-1035 2020-04-22
1417577271 Deborah Michelle Pavey Student in an Organized Health Care Education/Training Program 714 N Michigan St, South Bend, IN 46601-1035 2020-04-22
1841810702 Kaitlin Vanderkolk Student in an Organized Health Care Education/Training Program 714 N Michigan St, South Bend, IN 46601-1035 2020-04-21
1982224879 Allyson Nicole Dimagno Student in an Organized Health Care Education/Training Program 714 N Michigan St, South Bend, IN 46601-1035 2020-04-21
1609496686 Garrett Muhlstadt Student in an Organized Health Care Education/Training Program 714 N Michigan St, South Bend, IN 46601-1035 2020-04-20
1033748710 James Alan Handtke Student in an Organized Health Care Education/Training Program 714 N Michigan St, South Bend, IN 46601-1035 2020-04-05
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1447610449 David Thomas Hearing Instrument Specialist 808 S Michigan St., South Bend, IN 46601 2016-03-03
1285072454 Kevin Francis Cumper Internal Medicine 621 Memorial Dr Ste 624, South Bend, IN 46601 2013-06-11
1952605560 Robert Lusk Bonham Dentist 1222 L.w.e., So. Bend, IN 46601 2010-12-23
1649580911 Daniel Scott Debrule Psychologist 211 W. Washington Street, Suite 2311, South Bend, IN 46601 2010-10-20
1528390770 Luke Alfred White Internal Medicine 615 N. Michigan St., Memorial Hospital, C/o Erin Smith, South Bend, IN 46601 2010-02-12
1548497837 Tmg Home Health Care Home Health 108 N Main St #305, South Bend, IN 46601 2009-06-15
1225283039 Jody L. Hughes Counselor 202 S. Michigan Street, Suite 875, South Bend, IN 46601 2008-11-20
1740432574 Amanda Jayne Quicksall Social Worker 611 Lincolnway W, South Bend, IN 46601 2008-10-10
1952565772 Thomas P Judd Dentist 1901 #b Western Avenue, Ihc South Bend, South Bend, IN 46601 2008-07-10
1851590269 Warren Larry Penrod Nurse Practitioner 333 W. Western Ave, South Bend, IN 46601 2007-07-16
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Taxonomy Information

Taxonomy Code 363AM0700X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Medical

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1467909697 Sarah Anne Martin Physician Assistant 1815 E Ireland Rd, South Bend, IN 46614-2845 2016-09-06
1255884581 Anne E. Kinton Physician Assistant 2301 N Bendix Dr, Ste 500, South Bend, IN 46628-3486 2016-08-03
1912328360 Elizabeth Howe Physician Assistant 19567 Cleveland Rd, South Bend, IN 46637-3201 2014-01-01
1902141237 Randy Joseph Brush Physician Assistant 6301 University Commons, Suite 210, South Bend, IN 46635-1571 2012-11-27

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1063019289 Timothy Jeffirs Physician Assistant 10662 12th Rd, Argos, IN 46501-9551 2020-10-01
1093321788 April Marie Przyborski Physician Assistant 1701 S Creasy Ln Ste 2j20, Lafayette, IN 47905-4972 2020-09-18
1124634936 Brilyn Michelle Banister Physician Assistant 8443 Cabin Creek Dr Apt G, Indianapolis, IN 46237-6330 2020-09-17
1386290625 Douglas R Day Physician Assistant 1701 N Senate Blvd # Ag373a, Indianapolis, IN 46202-1239 2019-08-13
1841851409 Rachel Jagrowski Physician Assistant 1801 N Senate Blvd Ste 700, Indianapolis, IN 46202-1177 2019-06-25
1366003154 Jimmy Garala Physician Assistant 101 E 87th Ave Fl A3, Merrillville, IN 46410-7335 2019-06-24
1407311814 William Peter Thompson Physician Assistant 1801 N Capitol Ave # Npe120, Indianapolis, IN 46202-1217 2019-02-11
1669954475 Erika Vanelle Marin Physician Assistant 2680 Escalade Way, Warsaw, IN 46582 2018-08-29
1225518228 Jie Xu Physician Assistant 2072 E Commercial Ave, Lowell, IN 46356-2116 2018-08-19
1912492679 Katherine Barrett Tenbarge Physician Assistant 1800 N Capitol Ave # E140, Indianapolis, IN 46202-1218 2018-06-26
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Competitor

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City SOUTH BEND
Zip Code 46601

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Dataset Information

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.

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