Healthcare Provider Details

I. General information

NPI: 1033906219
Provider Name (Legal Business Name): FOURTH TRIMESTER WELLNESS JOURNEY'S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MUNICIPAL DR STE 200
FISHERS IN
46038-1634
US

IV. Provider business mailing address

11650 OLIO RD STE 1000-256
FISHERS IN
46037-7619
US

V. Phone/Fax

Practice location:
  • Phone: 463-215-7577
  • Fax:
Mailing address:
  • Phone: 463-215-7577
  • Fax: 463-583-8184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. KENELLE CORINE FREEMAN
Title or Position: OWNER/PROVIDER
Credential: DNP, PMHNP-BC,LCSW
Phone: 463-215-7577