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Individual
DEAN M KELLY
Active
Individual
DEAN M KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ANP
Taxonomy
Speciality
Code
Description
License number
State
363LX0106X
Occupational Health Nurse Practitioner
Primary
71000948B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000599883
ANTHEM
IN
01
—
000000625966
ANTHEM
IN
Enumeration date
03/06/2007
Last updated
12/11/2019
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