Healthcare Provider Details

I. General information

NPI: 1508788746
Provider Name (Legal Business Name): KELLY TEETER BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 W 71ST ST
INDIANAPOLIS IN
46268-2149
US

IV. Provider business mailing address

924 EAGLE CT
ZIONSVILLE IN
46077-9406
US

V. Phone/Fax

Practice location:
  • Phone: 317-347-5860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number7636-0183
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28296707A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: