Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 01028621A | IN |
NPI | 1740385525 |
---|---|
Provider Name | Rebecca H Kelly |
First Address | Indianapolis, IN 46256-4692 |
Second Address | Indianapolis, IN 46256-4692 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 01/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000809673 | ANTHEM (01) | IN |
000000810128 | ANTHEM (01) | IN |
4352781 | AETNA BEHAVIORAL HEALTH (01) | IN |