Individual
KATHERINE JOANN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5165 MCCARTY LN, LAFAYETTE, IN 47905-8764
(765) 448-8000
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
71014151A
IN
363LG0600X
Gerontology Nurse Practitioner
Primary
71014151A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1103705118
ANTHEM PTAN
IN
05
—
300081318
—
IN
01
—
Q00651574
RAILROAD PTAN
IN
Enumeration date
07/26/2023
Last updated
02/12/2025
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