MEDICARE: KELLY E CROWLEY NP

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
1	363LF0000X	Family Nurse Practitioner	71012221A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1102193309	OTHER	IN	ANTHEM BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730836982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY E CROWLEY NP

Provider Business Mailing Address
First Line	:	5215 HOLY CROSS PKWY
Second Line	:
City	:	MISHAWAKA
State	:	IN
Zip	:	46545-1469
Country	:	US
Telephone Number	:	574-335-8707
Fax Number	:

Provider Business Practice Location Address
First Line	:	12563 STATE ROAD 23
Second Line	:
City	:	GRANGER
State	:	IN
Zip	:	46530-9226
Country	:	US
Telephone Number	:	574-335-8300
Fax Number	:	574-335-0775

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	04/06/2026

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Directions to “ KELLY E CROWLEY NP” Practice Location

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