Individual
KELLY THEODORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP, FNP
Contact information
Practice address
111 E WISCONSIN AVE STE 1500, MILWAUKEE, WI 53202-4808
(262) 999-3495
Mailing address
4800 N SCOTTSDALE RD STE 2500, SCOTTSDALE, AZ 85251-7630
(262) 999-3495
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
6467
WI
363LF0000X
Family Nurse Practitioner
6467-33
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
6467
WI
Other
Enumeration date
07/15/2015
Last updated
05/22/2026
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