Individual
STACY A KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
705 RILEY HOSPITAL DR, ROC 4210, INDIANAPOLIS, IN 46202-5109
(317) 944-3774
(317) 944-8521
Mailing address
PO BOX 1026, INDIANAPOLIS, IN 46206-1026
(317) 274-1201
(317) 278-9905
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
28121823
IN
363LP0200X
Pediatric Nurse Practitioner
Primary
71001660
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200467770
—
IN
Enumeration date
10/19/2006
Last updated
10/14/2011
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