Provider Demographics
NPI:1497044390
Name:FREEMAN, KENELLE CORINE (DNP, PMHNP-BC, LCSW)
Entity type:Individual
Prefix:DR
First Name:KENELLE
Middle Name:CORINE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MUNICIPAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1634
Mailing Address - Country:US
Mailing Address - Phone:463-215-7577
Mailing Address - Fax:
Practice Address - Street 1:11 MUNICIPAL DR STE 200
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1634
Practice Address - Country:US
Practice Address - Phone:463-215-7577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007505A1041C0700X
IN71016387A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical