Healthcare Provider Details

I. General information

NPI: 1568017002
Provider Name (Legal Business Name): KELSEY L TRUEBLOOD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 EDSEL LN NW
CORYDON IN
47112-3008
US

IV. Provider business mailing address

PO BOX 270
PAOLI IN
47454-0270
US

V. Phone/Fax

Practice location:
  • Phone: 812-738-4251
  • Fax: 812-738-7833
Mailing address:
  • Phone: 812-723-3944
  • Fax: 812-723-7989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71009289A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71009289A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: