Healthcare Provider Details

I. General information

NPI: 1003265307
Provider Name (Legal Business Name): YVETTE MONIQUE CAVINESS-KELLEY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N MAIN ST # 304
CROWN POINT IN
46307-1877
US

IV. Provider business mailing address

1545 N MERIDIAN ST
INDIANAPOLIS IN
46202-2306
US

V. Phone/Fax

Practice location:
  • Phone: 574-546-1900
  • Fax: 574-546-1999
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71006741A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: