Individual
KELLY JEAN EDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CGC
Contact information
Practice address
1002 WISHARD BLVD STE 1100, INDIANAPOLIS, IN 46202-4164
(317) 944-3966
(317) 968-1354
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
170300000X
Genetic Counselor (M.S.)
Primary
74000347A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001424534
ANTHEM PTAN
IN
01
—
1102194716
ANTHEM PTAN
IN
05
—
300041098
—
IN
Enumeration date
06/09/2020
Last updated
02/21/2025
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