Individual
KELLY WAKEFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN.CNP
Contact information
Practice address
2700 LAFAYETTE ST, FORT WAYNE, IN 46806-1100
(260) 702-4404
(260) 744-3006
Mailing address
2700 LAFAYETTE ST, FORT WAYNE, IN 46806-1100
(260) 702-4404
(260) 744-3006
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
71009784A
IN
Other
Enumeration date
09/26/2019
Last updated
02/11/2020
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