Provider Demographics
NPI:1376001024
Name:BURTON, KELLI COELINE (FNP)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:COELINE
Last Name:BURTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:COELINE
Other - Last Name:LINSENMAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3403 E RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-4744
Mailing Address - Country:US
Mailing Address - Phone:317-957-2000
Mailing Address - Fax:
Practice Address - Street 1:3908 MEADOWS DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-3114
Practice Address - Country:US
Practice Address - Phone:317-957-2150
Practice Address - Fax:317-957-2160
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008850A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300023697Medicaid