Healthcare Provider Details

I. General information

NPI: 1043405178
Provider Name (Legal Business Name): KELLY MARIE BATTHAUER CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8402 HARCOURT RD STE 402
INDIANAPOLIS IN
46260-2053
US

IV. Provider business mailing address

8402 HARCOURT RD STE 402
INDIANAPOLIS IN
46260-2053
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-6563
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number71002083A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71002083A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: