Healthcare Provider Details

I. General information

NPI: 1053506154
Provider Name (Legal Business Name): DEBORAH D KELTY RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBORAH D PERKINS RNFA

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 OLD VINCENNES RD
NEW ALBANY IN
47150-5494
US

IV. Provider business mailing address

2495 OLD VINCENNES ROAD
NEW ALBANY IN
47150-5494
US

V. Phone/Fax

Practice location:
  • Phone: 502-499-2197
  • Fax:
Mailing address:
  • Phone: 502-499-2197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number1048311
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: