MEDICARE: KELLY PATRICE PATTON-BOYD DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	71009838A	IN

General Provider Information

NPI Number	:	1912531948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY PATRICE PATTON-BOYD DNP

Provider Business Mailing Address
First Line	:	101 E 34TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-3408
Country	:	US
Telephone Number	:	317-924-4545
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 E 34TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-3408
Country	:	US
Telephone Number	:	317-924-4545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2020
Last Update Date	:	02/28/2020

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