Active NPI
Kiara L Glenn
- Supports Brokerage Agency
- Indianapolis, IN
National Provider Identifier
1710734678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Supports Brokerage Agency
- License
- 23-016111-1
- Practice address
- 645 W 29TH St
Indianapolis, IN 46208-5009 - Phone
- (317) 444-1784
- NPI assigned
- Apr 30, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Supports Brokerage Agency | 251X00000X | 23-016111-1 | IN | Primary |
Addresses
Primary practice location
645 W 29TH St
Indianapolis, IN 46208-5009
Mailing address
645 W 29TH St
Indianapolis, IN 46208-5009
Phone (317) 444-1784
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300080784 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23-016111-1 | IN | MD | Supports Brokerage Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715040000000",
"number": "1710734678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "645 W 29TH ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462085009",
"telephone_number": "317-444-1784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "645 W 29TH ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462085009",
"telephone_number": "317-444-1784"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLENN",
"first_name": "KIARA",
"middle_name": "L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-04-30",
"last_updated": "2024-05-07",
"certification_date": "2024-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "251X00000X",
"taxonomy_group": "",
"desc": "Supports Brokerage",
"state": "IN",
"license": "23-016111-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "300080784",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.