Individual
KELLY L BURROUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1095 BROAD RIPPLE AVE, INDIANAPOLIS, IN 46220-2034
(317) 621-3731
(317) 621-4037
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-3684
(317) 257-3689
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71000164A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000542085
ANTHEM
IN
05
—
200945510
—
IN
01
—
P01227319
MEDICARE RAILROAD
IN
Enumeration date
05/25/2006
Last updated
11/27/2023
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