Individual
MRS. KELLI ROSE ROE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4813 NEW HAVEN AVE, FORT WAYNE, IN 46803-3018
(260) 449-7504
Mailing address
4813 NEW HAVEN AVE, FORT WAYNE, IN 46803-3018
(260) 449-7504
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
28181384A
IN
Other
Enumeration date
10/24/2017
Last updated
01/22/2021
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