Individual
KEELY R PHELPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1701 N SENATE BLVD, RM DG412, INDIANAPOLIS, IN 46202-1239
(317) 962-3886
(317) 963-5492
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001329A
IN
363A00000X
Physician Assistant
99048685
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000749492
ANTHEM BC/BS PIN
IN
Enumeration date
09/23/2011
Last updated
02/14/2025
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