Healthcare Provider Details

I. General information

NPI: 1730836982
Provider Name (Legal Business Name): KELLY E CROWLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12563 STATE ROAD 23
GRANGER IN
46530-9226
US

IV. Provider business mailing address

707 CEDAR ST STE 405
SOUTH BEND IN
46617-2059
US

V. Phone/Fax

Practice location:
  • Phone: 574-335-8300
  • Fax: 574-335-0775
Mailing address:
  • Phone: 574-335-8707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71012221A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: