Provider Demographics
NPI:1174418701
Name:MCCOLLUM, NOAH BENJAMIN (PA-C)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:BENJAMIN
Last Name:MCCOLLUM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:113 N COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-3218
Mailing Address - Country:US
Mailing Address - Phone:765-717-9427
Mailing Address - Fax:
Practice Address - Street 1:113 N COVENTRY DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-3218
Practice Address - Country:US
Practice Address - Phone:765-717-9427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant