Healthcare Provider Details

I. General information

NPI: 1730944877
Provider Name (Legal Business Name): ASHLEY KELLY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MITCHELL AVE
BATESVILLE IN
47006-8909
US

IV. Provider business mailing address

PO BOX 236
BATESVILLE IN
47006-0236
US

V. Phone/Fax

Practice location:
  • Phone: 812-933-5406
  • Fax:
Mailing address:
  • Phone: 812-933-5441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71015042A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: