Active NPI
Holly R. Kelly, N.P.
- Nurse Practitioner
- Plymouth, IN
National Provider Identifier
1750630786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 71004121A
- Practice address
- 2855 Miller Dr Ste 121B
Plymouth, IN 46563-8091 - Phone
- (574) 522-0265
- Fax
- (574) 406-0025
- NPI assigned
- Sep 6, 2012
- Last updated
- May 14, 2026
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 71004121A | IN | Primary |
Addresses
Primary practice location
2855 Miller Dr Ste 121B
Plymouth, IN 46563-8091
Mailing address
211 N Eddy St
South Bend, IN 46617-2808
Phone (574) 237-9231
Other practice location 1
111 N Nappanee St
Elkhart, IN 46514-1957
Phone (574) 522-0265
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201092360 | Medicaid | IN |
Other names 1
- Holly R. Sucharetza
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121005000658 | IN | Practitioner - Nurse Practitioner | 6507015559 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71004121A | IN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778716800000",
"number": "1750630786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 N EDDY ST",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466172808",
"telephone_number": "574-237-9231",
"fax_number": "574-204-6355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2855 MILLER DR STE 121B",
"city": "PLYMOUTH",
"state": "IN",
"postal_code": "465638091",
"telephone_number": "574-522-0265",
"fax_number": "574-406-0025"
}
],
"practiceLocations": [
{
"address_1": "111 N Nappanee St",
"address_purpose": "LOCATION",
"city": "Elkhart",
"state": "IN",
"postal_code": "465141957",
"country_code": "US",
"telephone_number": "574-522-0265",
"fax_number": "574-406-0025",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KELLY",
"first_name": "HOLLY",
"middle_name": "R.",
"credential": "N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-06",
"last_updated": "2026-05-14",
"certification_date": "2026-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IN",
"license": "71004121A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201092360",
"state": "IN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "HOLLY",
"last_name": "SUCHARETZA",
"middle_name": "R.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Plymouth, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.