Active NPI
Audrey Jill Kelly
- Speech-Language Pathologist
- Indianapolis, IN
National Provider Identifier
1386879591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 22004633A
- Practice address
- 5908 Blackley LN
Indianapolis, IN 46254-6101 - Phone
- (317) 514-5365
- NPI assigned
- May 18, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 22004633A | IN | Primary |
Addresses
Primary practice location
5908 Blackley LN
Indianapolis, IN 46254-6101
Mailing address
5908 Blackley LN
Indianapolis, IN 46254-6101
Phone (317) 514-5365
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22004633A | IN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242604800000",
"number": "1386879591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5908 BLACKLEY LN",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462546101",
"telephone_number": "317-514-5365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5908 BLACKLEY LN",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462546101",
"telephone_number": "317-514-5365"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "AUDREY",
"middle_name": "JILL",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-05-18",
"last_updated": "2009-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IN",
"license": "22004633A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.