KELSEY WIDEMAN (NPI# 1124495650) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
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 |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363AM0700X |
Physician Assistant Specialization: Medical |
10001856A | IN | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
IN | 300006438 | 05 |
Address | Telephone Number | Fax Number |
---|---|---|
5215 Holy Cross Parkway, Mishawaka, IN 465451469 | 5745233160 |
Street Address |
714 N MICHIGAN ST |
City | SOUTH BEND |
State | IN |
Zip Code | 46601 |
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 |
Find all providers in the same location |
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 |
Find all providers in zip 46601 |
Taxonomy Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
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 |
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 |
Find all providers with the same taxonomy |
City | SOUTH BEND |
Zip Code | 46601 |
Please comment or provide details below to improve the information on KELSEY WIDEMAN.
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.