Kelli L Arnold, NP
Individual provider Active NPI Nurse Practitioner · Crown Point, IN
NPI 1477549665 · NPPES record last updated Aug 16, 2013
Key facts
- NPI
- 1477549665
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 28126405A (IN)
- Practice address
- 9301 Madison St
Crown Point, IN 46307-7745 - Phone
- (219) 662-5065
- NPI assigned
- Sep 22, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130909000639 | IN | Order and Referring Only - Nurse Practitioner | 6406829670 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28126405A | IN | MD | Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 28126405A | IN | Yes |
Addresses
Primary practice location
9301 Madison St
Crown Point, IN 46307-7745
Mailing address
9301 Madison St
Crown Point, IN 46307-7745
Phone (219) 662-5065
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200290230 | Medicaid | IN |
Other providers in Crown Point, IN
- Arc Bridges, Inc
- Andrea M Arce
- Arch Complete Family Dental Group, Inc.
- Rommel Panaligan Arevalo
- Heather Arnold
- Susan R Arnold
- Jonna Marie Arseneault
- Anita D Arthur
- Rida Aslam
- At Home by Choice Home Care LLC
All providers in Crown Point, IN · Nurse Practitioner in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.