Kelly, Holly R.

Kelly, Holly R. is an individual health care provider with primary practice located at 211 N Eddy St , South Bend IN 46617-2808. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Kelly, Holly R. can be contacted via phone (574) 237-9231.

Contact Information

Primary practice address
211 N Eddy St South Bend IN 46617-2808
Phone: (574) 237-9231
Fax: (574) 204-6355
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 71004121A Indiana

Profile Details

NPI number 1750630786
LBN Legal business name Kelly, Holly R.
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 6th, 2012
Last updated Dec 15th, 2014 - about 12 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 1750630786 NPPES
Indiana MEDICAID 201092360

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