Individual
KESHA RAE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
8091 TOWNSHIP LINE RD STE 206, INDIANAPOLIS, IN 46260-2495
(317) 415-1000
(317) 415-1010
Mailing address
8091 TOWNSHIP LINE RD STE 206, INDIANAPOLIS, IN 46260-2495
(317) 415-1000
(317) 415-1010
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
71001948A
IN
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
71001948A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200540450
—
IN
Enumeration date
05/28/2008
Last updated
09/06/2024
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