Individual
LACEY KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
8075 N SHADELAND AVE, STE 200, INDIANAPOLIS, IN 46250-2693
(317) 621-8640
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28187969A
IN
363LG0600X
Gerontology Nurse Practitioner
Primary
71006524A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201399380
—
IN
Enumeration date
07/29/2016
Last updated
06/15/2021
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