Individual
KELLY J. EDSALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7250 CLEARVISTA DR STE 260, INDIANAPOLIS, IN 46256-4686
(317) 621-1695
(317) 621-1699
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-7588
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28189674A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71008649A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300021436
—
IN
Enumeration date
06/14/2018
Last updated
11/27/2023
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