Provider Demographics
NPI:1659670388
Name:KELLY, BARBARA BOGARD (FNP-BC)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:BOGARD
Last Name:KELLY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E HANNA AVE
Mailing Address - Street 2:UNIVERSITY OF INDIANPOLIS, KOVAL NURSING CENTER
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-3630
Mailing Address - Country:US
Mailing Address - Phone:317-788-6110
Mailing Address - Fax:317-788-6208
Practice Address - Street 1:1400 E HANNA AVE
Practice Address - Street 2:UNIVERSITY OF INDIANPOLIS, KOVAL NURSING CENTER
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-3630
Practice Address - Country:US
Practice Address - Phone:317-788-6110
Practice Address - Fax:317-788-6208
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28062042A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily