Provider Demographics
NPI:1780617340
Name:BRESSLER, KELLY SUE (NP-C, DNP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:SUE
Last Name:BRESSLER
Suffix:
Gender:F
Credentials:NP-C, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 NW STATE ROAD 116-90
Mailing Address - Street 2:
Mailing Address - City:MARKLE
Mailing Address - State:IN
Mailing Address - Zip Code:46770-9723
Mailing Address - Country:US
Mailing Address - Phone:260-602-6122
Mailing Address - Fax:
Practice Address - Street 1:13821 LEO RD
Practice Address - Street 2:
Practice Address - City:LEO CEDARVILLE
Practice Address - State:IN
Practice Address - Zip Code:46765-9400
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001968A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN295910SSSSMedicare ID - Type Unspecified
IN138420A2Medicare ID - Type Unspecified
IN142520SSMedicare ID - Type Unspecified
IN178650KKMedicare ID - Type Unspecified
Q51813Medicare UPIN