Healthcare Provider Details

I. General information

NPI: 1912813734
Provider Name (Legal Business Name): KELSEY DAWN GILLILAND FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W BLOOMFIELD RD UNIT C
BLOOMINGTON IN
47403-2001
US

IV. Provider business mailing address

3326 BLUE GATE DR
SPENCER IN
47460-5242
US

V. Phone/Fax

Practice location:
  • Phone: 812-334-2772
  • Fax:
Mailing address:
  • Phone: 812-345-2389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28243552A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: