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Individual
TYLER P KELLY
Active
Individual
TYLER P KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71005109A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201252820
—
IN
01
—
28189341A
RN LICENSE
IN
01
—
71005109A
APN PRESCRIPTIVE AUTHORITY
IN
01
—
71005109B
CSR PRESCRIPTIVE AUTHORITY
IN
Enumeration date
07/11/2014
Last updated
01/07/2025
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