Dean M Kelly, ANP

Primary specialty

Occupational Health Nurse PractitionerTaxonomy code 363LX0106X

License

71000948B Issued in IN

Practice address

3218 Daugherty Dr Ste 140
Lafayette, IN 47909-3997

Phone

(765) 502-4190

Fax

(765) 502-4191

NPI assigned

Mar 6, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Franciscan Physician Network

  • Clinic/Center
  • Lafayette, IN
  • NPI 1992543250
  NPD (past)
• Roccwell, LLC

  • Occupational Medicine Physician
  • Lafayette, IN
  • NPI 1790809788
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576022400000",
    "number": "1639209174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "760 PARK EAST BLVD STE 5",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479050796",
            "telephone_number": "765-447-7473",
            "fax_number": "765-449-8504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3218 DAUGHERTY DR STE 140",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479093997",
            "telephone_number": "765-502-4190",
            "fax_number": "765-502-4191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "DEAN",
        "middle_name": "M",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-06",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0106X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Occupational Health",
            "state": "IN",
            "license": "71000948B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000599883",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000625966",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David W Kelley, D.O.
• Jack Leslie Kelley, MD
• Kelly Nutrition, LLC
• Bryan Kelly
• Christi Gay Kelly, RN
• Katherine Joann Kelly, NP
• Lindsey Rae Kemper, PHARMD
• Tiffany Jo-Anne Kendall
• Brittany Chana'Is Kendrick, CNM
• Sarah E Kennedy, PHARMD

• Occupational Health Nurse Practitioner in Lafayette, IN
• Providers in Lafayette, IN by specialty
• Occupational Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.