Provider Demographics
NPI:1952042566
Name:KELLEY, JULIA RENEE
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:RENEE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8606 N 850 E
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:IN
Mailing Address - Zip Code:46552-9047
Mailing Address - Country:US
Mailing Address - Phone:574-298-7950
Mailing Address - Fax:
Practice Address - Street 1:8606 N 850 E
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:IN
Practice Address - Zip Code:46552-9047
Practice Address - Country:US
Practice Address - Phone:574-298-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program