Individual
KELLI JOY BOVENKERK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3834 S EMERSON AVE, BUILDING C, SUITE 100, INDIANAPOLIS, IN 46203
(775) 222-0044
(888) 700-0187
Mailing address
PO BOX 3299, CARSON CITY, NV 89702-3299
(317) 782-1577
(317) 780-5538
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
71006606A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201398720
—
IN
Enumeration date
10/12/2016
Last updated
10/03/2018
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