Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 71001008A | IN |
NPI | 1003875964 |
---|---|
Provider Name | Kelli Shea Dempsey |
First Address | Cincinnati, OH 45263-7273 |
Second Address | Newburgh, IN 47630-8947 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2006 |
Last Update Date | 24/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TB5420 | (02) | IN |