Healthcare Provider Details

I. General information

NPI: 1184378275
Provider Name (Legal Business Name): KELLY ANNE LEARD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15763 VITALIZE RUN
FISHERS IN
46040-0168
US

IV. Provider business mailing address

15763 VITALIZE RUN
FISHERS IN
46040-0168
US

V. Phone/Fax

Practice location:
  • Phone: 312-731-6432
  • Fax:
Mailing address:
  • Phone: 312-731-6432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71012263A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71012263A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28231757A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: