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General NPI Number Information
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NPI Number | 1740623156
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Entity Type | Individual
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Provider Name | CHRISTINA MARIE KELLEY NP
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Gender | Female
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Dates
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Enumeration Date | 04/16/2013
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Last Update Date | 03/05/2021
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Provider Practice Location Address
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Address Line | 301 SATORI PKWY STE 200
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City | AVON
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State | IN
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Zip | 46123-6407
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Country | US
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Telephone | 317-271-6363
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Fax | 317-271-7600
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Provider Business Mailing Address
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Address Line | 1100 SOUTHFIELD DR STE 1370
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City | PLAINFIELD
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State | IN
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Zip | 46168-4300
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Country | US
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Telephone | 317-837-5566
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Fax | 317-837-5580
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 28156791A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | 71004498B
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 71004498A
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License Number State | IN
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