Individual
KELLY L WARREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
8075 N SHADELAND AVE, SUITE 200, INDIANAPOLIS, IN 46250-2693
(317) 621-8500
(317) 621-8501
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28177166A
IN
363L00000X
Nurse Practitioner
Primary
71004533A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01307616
MEDICARE RR PTAN
IN
Enumeration date
07/24/2013
Last updated
06/30/2014
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