# KELLY L WARREN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1326480948
- **Gender:** F
- **Credential:** NURSE PRACTITIONER

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163W00000X | Registered Nurse | 28177166A | IN | — |
| 363L00000X | Nurse Practitioner | 71004533A | IN | Yes |

## Other

- **Enumeration date:** 07/24/2013
- **Last updated:** 06/30/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | P01307616 | MEDICARE RR PTAN | IN |