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NPI Code Detail

MEDICARE: MRS. KAREN RAE KELLY MSN

MEDICARE: MRS. KAREN RAE KELLY MSN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner28072059AIN
2363LF0000XFamily Nurse Practitioner71000355BIN
3363LF0000XFamily Nurse Practitioner71000355AIN

General Provider Information

NPI Number : 1447245436
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KAREN RAE KELLY MSN
Provider Business Mailing Address
First Line : 1520 FRIENDSHIP DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46217-4428
Country : US
Telephone Number : 317-888-1115
Fax Number :
Provider Business Practice Location Address
First Line : 9805 GEIST CROSSING DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46256-4819
Country : US
Telephone Number : 612-659-7111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2005
Last Update Date : 07/08/2007

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