Healthcare Provider Details

I. General information

NPI: 1831020866
Provider Name (Legal Business Name): KERRY ELIZABETH KENNATH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 W 16TH ST
INDIANAPOLIS IN
46202-2207
US

IV. Provider business mailing address

355 W 16TH ST
INDIANAPOLIS IN
46202-2207
US

V. Phone/Fax

Practice location:
  • Phone: 317-948-5450
  • Fax:
Mailing address:
  • Phone: 317-948-5450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95113989
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28293443A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: