Provider Demographics
NPI:1518379130
Name:ELDER, KELLY LYNN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LYNN
Last Name:ELDER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LYNN
Other - Last Name:OMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2075 INDIANAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:IN
Mailing Address - Zip Code:46394-1948
Mailing Address - Country:US
Mailing Address - Phone:219-659-9000
Mailing Address - Fax:219-659-0944
Practice Address - Street 1:2838 45TH ST STE A
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2905
Practice Address - Country:US
Practice Address - Phone:219-924-1042
Practice Address - Fax:219-924-7989
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28188714A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner