Basic Information
| Provider Information | |||||||||
| NPI: | 1457975740 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLEEMIE | ||||||||
| FirstName: | AYEE | ||||||||
| MiddleName: | TEAH | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6907 ENNIS DR | ||||||||
| Address2: | |||||||||
| City: | BROWNSBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461125603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737157219 | ||||||||
| FaxNumber: | 3176598825 | ||||||||
| Practice Location | |||||||||
| Address1: | 429 E VERMONT ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462023688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175590950 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2020 | ||||||||
| LastUpdateDate: | 09/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 71010114A | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LF0000X | 71010114A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.