Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 71003814A | IN |
NPI | 1366715492 |
---|---|
Provider Name | Mrs. Kelley Ann Thompson |
First Address | Merrillville, IN 46410-5719 |
Second Address | Crown Point, IN 46307-8481 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2012 |
Last Update Date | 21/02/2012 |