Provider Demographics
NPI:1194392787
Name:WOKER, KELLY (MSN, RN, AGCNS-BC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:WOKER
Suffix:
Gender:F
Credentials:MSN, RN, AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 CLEARVISTA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-4643
Mailing Address - Country:US
Mailing Address - Phone:317-621-8504
Mailing Address - Fax:
Practice Address - Street 1:7250 CLEARVISTA DR STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4643
Practice Address - Country:US
Practice Address - Phone:317-621-8504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28150724A364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist