Provider Demographics
NPI:1881158236
Name:CROWE, KELLY DENISE (FNP-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:DENISE
Last Name:CROWE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8326 E 56TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216-2001
Mailing Address - Country:US
Mailing Address - Phone:702-323-1742
Mailing Address - Fax:
Practice Address - Street 1:5023 E 56TH ST STE 110
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-1471
Practice Address - Country:US
Practice Address - Phone:317-565-7217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009618A363L00000X
OR202202031NP363L00000X
NV818071363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner