Healthcare Provider Details

I. General information

NPI: 1306518634
Provider Name (Legal Business Name): KELSEY SAMMET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4199 GATEWAY BLVD STE 3500
NEWBURGH IN
47630-7909
US

IV. Provider business mailing address

4199 GATEWAY BLVD STE 3500
NEWBURGH IN
47630-7909
US

V. Phone/Fax

Practice location:
  • Phone: 812-858-5950
  • Fax: 812-858-5955
Mailing address:
  • Phone: 812-858-5950
  • Fax: 812-858-5955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71011594A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: