Provider Demographics
NPI:1144971839
Name:DEMERLY, RACHEL KATHRYN (NP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:KATHRYN
Last Name:DEMERLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:K
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6866 W STONEGATE DR STE 100
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-8051
Practice Address - Country:US
Practice Address - Phone:317-678-6000
Practice Address - Fax:317-768-6015
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF02210118363L00000X
IN71012156A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INQ00395648OtherRAILROAD PTAN
IN000001643084OtherANTHEM PTAN
IN300060789Medicaid
INQ00348088OtherRAILROAD PTAN
IN000001636281OtherANTHEM PTAN