Healthcare Provider Details

I. General information

NPI: 1447873682
Provider Name (Legal Business Name): SHELLEY E KESTLER R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE MEMORIAL SQUARE SUITE 2200
GREENFIELD IN
46140-1378
US

IV. Provider business mailing address

ONE MEMORIAL SQUARE SUITE 50
GREENFIELD IN
46140-1270
US

V. Phone/Fax

Practice location:
  • Phone: 317-462-6662
  • Fax: 317-468-6275
Mailing address:
  • Phone: 317-468-3257
  • Fax: 317-468-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number28258763A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: