Provider Demographics
NPI:1265160394
Name:VARGAS, KELSI ANNE (NP-C)
Entity type:Individual
Prefix:
First Name:KELSI
Middle Name:ANNE
Last Name:VARGAS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KELSI
Other - Middle Name:ANNE
Other - Last Name:FORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2511 SOLANA WAY UNIT 101
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-3099
Mailing Address - Country:US
Mailing Address - Phone:765-425-8328
Mailing Address - Fax:
Practice Address - Street 1:1545 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2306
Practice Address - Country:US
Practice Address - Phone:317-923-1491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012846A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily