Individual
DEAN M KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ANP
Contact information
Practice address
3218 DAUGHERTY DR STE 140, LAFAYETTE, IN 47909-3997
(765) 502-4190
(765) 502-4191
Mailing address
760 PARK EAST BLVD STE 5, LAFAYETTE, IN 47905-0796
(765) 447-7473
(765) 449-8504
Taxonomy
Speciality
Code
Description
License number
State
363LX0106X
Occupational Health Nurse Practitioner
Primary
71000948B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000599883
ANTHEM
IN
01
—
000000625966
ANTHEM
IN
Enumeration date
03/06/2007
Last updated
12/11/2019
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