Healthcare Provider Details

I. General information

NPI: 1659315315
Provider Name (Legal Business Name): KATHERINE MONICA KELLY RN/NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 17TH ST
COLUMBUS IN
47201-5351
US

IV. Provider business mailing address

203 E MAIN ST
RICHMOND IN
47374-4208
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-5016
  • Fax: 812-376-5928
Mailing address:
  • Phone: 765-973-9294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number28122181A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000702A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: