Provider Demographics
NPI:1942933015
Name:VELAZQUEZ, KERA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KERA
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KERA
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12218 CHESTERBROOK CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1966
Mailing Address - Country:US
Mailing Address - Phone:260-573-1409
Mailing Address - Fax:
Practice Address - Street 1:12218 CHESTERBROOK CT
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1966
Practice Address - Country:US
Practice Address - Phone:260-573-1409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28207853A163WH0200X
IN71013255A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0200XNursing Service ProvidersRegistered NurseHome Health