Provider Demographics
NPI:1952928020
Name:MCKELVEY, CALLIE C (CST, CSFA)
Entity Type:Individual
Prefix:MS
First Name:CALLIE
Middle Name:C
Last Name:MCKELVEY
Suffix:
Gender:F
Credentials:CST, CSFA
Other - Prefix:MS
Other - First Name:CALLIE
Other - Middle Name:A
Other - Last Name:CONNAUGHTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSFA
Mailing Address - Street 1:8450 NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1381
Mailing Address - Country:US
Mailing Address - Phone:317-802-2000
Mailing Address - Fax:317-802-2170
Practice Address - Street 1:8450 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1381
Practice Address - Country:US
Practice Address - Phone:317-802-2000
Practice Address - Fax:317-802-2170
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant