Individual
KELSEY RADER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3920 ST FRANCIS WAY STE 209, LAFAYETTE, IN 47905-4917
(765) 775-2830
(765) 775-2826
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71009124A
IN
363LF0000X
Family Nurse Practitioner
Primary
71009124A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71009124A
APN LICENSE
IN
Enumeration date
07/19/2019
Last updated
03/01/2024
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