Individual
MISS KELLEY ANN GANTNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NNP-BC
Contact information
Practice address
8111 S EMERSON AVE, INDIANAPOLIS, IN 46237-8601
(317) 865-5541
(317) 865-5148
Mailing address
PO BOX 1026, INDIANAPOLIS, IN 46206-1026
(317) 777-6435
(317) 777-6644
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
28131736A
IN
363LN0000X
Neonatal Nurse Practitioner
Primary
71003558A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201154390
—
IN
Enumeration date
02/29/2012
Last updated
01/27/2021
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