Individual
KELLI HOLLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3156 WILLOWCREEK RD, PORTAGE, IN 46368-4424
(219) 762-9444
Mailing address
3156 WILLOWCREEK RD, PORTAGE, IN 46368-4424
(219) 762-9444
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71013530A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71013530A
LICENSE
IN
Enumeration date
02/02/2023
Last updated
02/02/2023
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