Kirsten E Ault, PTA
Individual provider Active NPI Specialist · Medora, IN
NPI 1831366053 · NPPES record last updated May 15, 2008
Key facts
- NPI
- 1831366053
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 06003508A (IN)
- Practice address
- 9418 W County Road 300 S
Medora, IN 47260-9709 - Phone
- (812) 521-0054
- Fax
- (812) 966-2407
- NPI assigned
- May 15, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06003508A | IN | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 06003508A | IN | Yes |
Addresses
Primary practice location
9418 W County Road 300 S
Medora, IN 47260-9709
Mailing address
9418 W County Road 300 S
Medora, IN 47260-9709
Phone (812) 521-0054
Other providers in Medora, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.