Healthcare Provider Details

I. General information

NPI: 1376839852
Provider Name (Legal Business Name): HEATHER P KELKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER M PETRASEK

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RILEY HOSPITAL DR
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-3886
  • Fax: 317-962-8652
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01079277A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number35-124393
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number01079277A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: