Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 71006741A | IN |
NPI | 1003265307 |
---|---|
Provider Name | Mrs. Yvette Monique Caviness-Kelley |
First Address | Indianapolis, IN 46290-1024 |
Second Address | Indianapolis, IN 46216-2003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2016 |
Last Update Date | 12/12/2017 |