Provider Demographics
NPI:1255682894
Name:KILRAIN, KELLIE ANN (PNP)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:ANN
Last Name:KILRAIN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8003 CASTLEWAY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1946
Mailing Address - Country:US
Mailing Address - Phone:317-576-1335
Mailing Address - Fax:844-397-1311
Practice Address - Street 1:3118 S LAFOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3710
Practice Address - Country:US
Practice Address - Phone:765-864-4160
Practice Address - Fax:844-397-1312
Is Sole Proprietor?:No
Enumeration Date:2012-09-23
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71004200A363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201166040Medicaid
IN201166040Medicaid