Individual
KELSEA KAY LEROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
11123 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1707
(260) 425-6650
Mailing address
11109 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28222424A
IN
363L00000X
Nurse Practitioner
Primary
71010736A
IN
Other
Enumeration date
11/06/2020
Last updated
10/14/2022
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