Provider Demographics
NPI:1659861912
Name:KANALEY, KERRY ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:ANN
Last Name:KANALEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:ANN
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8135 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1701
Mailing Address - Country:US
Mailing Address - Phone:219-513-2000
Mailing Address - Fax:
Practice Address - Street 1:8135 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1701
Practice Address - Country:US
Practice Address - Phone:219-513-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-12
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27065033A164W00000X
IN71008016A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse