=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083815450
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAYME E KELLY APRN BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2007
-----------------------------------------------------
Last Update Date | 04/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 416 SUNNYSIDE AVE
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47001-1526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-468-1780
-----------------------------------------------------
Fax | 317-968-1485
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 416 SUNNYSIDE AVE
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47001-1526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-468-1780
-----------------------------------------------------
Fax | 317-968-1485
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | ARNP 5095P
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | COA.12313.NP
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.12313
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 364SP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | 71003051A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 364SP0810X
-----------------------------------------------------
Taxonomy Name | Child & Family Psychiatric/Mental Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | 832428
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 832428
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------