Healthcare Provider Details

I. General information

NPI: 1447744420
Provider Name (Legal Business Name): CASSANDRA NICOLE KELLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19800 EAST ST STE 120
WESTFIELD IN
46074-3833
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-7120
  • Fax: 317-621-7119
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01087872A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: