Clark, Kelly Marie

Clark, Kelly Marie is an individual health care provider with primary practice located at 705 Riley Hospital Dr Rr208, Indianapolis IN 46202-5109. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Neonatal, which is considered as her primary health care specialty. Clark, Kelly Marie can be contacted via phone (317) 274-4715.

Contact Information

Primary practice address
705 Riley Hospital Dr Rr208 Indianapolis IN 46202-5109
Phone: (317) 274-4715
Fax: (317) 274-2065
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Neonatal 363LN0000X 28159429 Indiana
Physician Assistants & Advanced Practice Nursing Providers / Neonatal 363LN0000X 71005589A Indiana

Profile Details

NPI number 1972988913
LBN Legal business name Clark, Kelly Marie
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 20th, 2015
Last updated Feb 1st, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1972988913 NPPES
Indiana MEDICAID 201341670

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