Individual
KELLY SUE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP-BC
Contact information
Practice address
6401 E WASHINGTON ST, INDIANAPOLIS, IN 46219-6614
(317) 808-7085
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
28146332A
IN
Other
Enumeration date
11/16/2015
Last updated
01/14/2021
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