Individual
KELLY R DOMENECH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
355 W 16TH ST STE 2800, INDIANAPOLIS, IN 46202-2279
(317) 963-7300
(317) 963-7075
Mailing address
355 W 16TH ST STE 2800, INDIANAPOLIS, IN 46202-2279
(317) 963-7300
(317) 963-7075
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71017023A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71017023A
IN
Other
Enumeration date
08/27/2025
Last updated
09/09/2025
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