Healthcare Provider Details

I. General information

NPI: 1467027367
Provider Name (Legal Business Name): MARY KALEIGH OKERSON AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W SMITH VALLEY RD STE A2
GREENWOOD IN
46142-1589
US

IV. Provider business mailing address

1700 W SMITH VALLEY RD STE A2
GREENWOOD IN
46142-1589
US

V. Phone/Fax

Practice location:
  • Phone: 317-640-0514
  • Fax:
Mailing address:
  • Phone: 317-640-0514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number28191376A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number71011039A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: