Provider Demographics
NPI:1902853682
Name:GOLETZ, KIMBERLY ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:GOLETZ
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1260 INNOVATION PKWY
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-3601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1260 INNOVATION PKWY
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-3601
Practice Address - Country:US
Practice Address - Phone:317-884-5200
Practice Address - Fax:317-884-5360
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2024-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH50002290363A00000X
IN10000544A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant