Healthcare Provider Details

I. General information

NPI: 1699003798
Provider Name (Legal Business Name): KELLY KEMPER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 WILSON CREEK RD
LAWRENCEBURG IN
47025-1095
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 812-496-7710
  • Fax: 812-496-7711
Mailing address:
  • Phone: 812-496-7710
  • Fax: 812-496-7711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71003546A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3006290
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28139991A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: