Individual
LATONYA R KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OWNER
Contact information
Practice address
6517 ROYAL OAKLAND DR, INDIANAPOLIS, IN 46236-4805
(317) 657-0510
Mailing address
6517 ROYAL OAKLAND DR, INDIANAPOLIS, IN 46236-4805
(317) 657-0510
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
300047703
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300047703
—
IN
Enumeration date
04/01/2021
Last updated
04/01/2021
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