Individual
KELLEY R EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
244 WESTWOOD BLVD, COLUMBUS, IN 47201-5687
(812) 669-0141
(812) 799-7062
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 663-9008
(920) 684-1439
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71006506A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201386320
—
IN
01
—
IN1125026
MEDICARE PTAN
IN
01
—
IN1127025
MEDICARE PTAN
IN
Enumeration date
09/02/2016
Last updated
11/12/2025
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