Provider Demographics
NPI:1154681096
Name:ABSHEAR, KELLI M (NP)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:M
Last Name:ABSHEAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-489-3935
Mailing Address - Fax:765-489-6344
Practice Address - Street 1:4829 N STATE ROAD 1
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47346-9620
Practice Address - Country:US
Practice Address - Phone:765-489-3935
Practice Address - Fax:765-489-6344
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71003967A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000770719OtherANTHEM
OH0068876Medicaid
IN201069460Medicaid
INM400071342Medicare PIN