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General NPI Number Information
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NPI Number | 1821454356
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Entity Type | Individual
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Provider Name | TINA KELLEY NP-C
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Gender | Female
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Dates
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Enumeration Date | 01/13/2016
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Last Update Date | 01/13/2016
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Provider Practice Location Address
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Address Line | 4 NE 21ST ST SUITE 3
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City | WASHINGTON
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State | IN
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Zip | 47501-3114
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Country | US
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Telephone | 812-257-1052
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Fax | 812-257-1061
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Provider Business Mailing Address
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Address Line | 4 NE 21ST ST SUITE 3
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City | WASHINGTON
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State | IN
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Zip | 47501-3114
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Country | US
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Telephone | 812-257-1052
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Fax | 812-257-1061
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F0116190
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License Number State | IN
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