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KELLI M BURRESS NP
Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1912203894
Individual Registrant: KELLI M BURRESS NP
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
1152 E US HIGHWAY 36 BAINBRIDGE, IN 46105-9604 US
Tel: 765-522-1889 Fax: 765-522-3583
Tel: 765-522-1889 Fax: 765-522-3583
Contact information for business:
1100 SOUTHFIELD DR STE 1370 PLAINFIELD, IN 46168-4300 US
Tel: 317-837-5566 Fax: 317-837-5580
Tel: 317-837-5566 Fax: 317-837-5580
Registration Information:
NPI: 1912203894
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Family | IN | 71003520A |
| N | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | IN | 71003520 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 201019020 | IN | 05 |
