Provider Demographics
NPI:1902884646
Name:SAMSON, KELLY AKIN (MS, CGC)
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:AKIN
Last Name:SAMSON
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 RESERVE WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1883
Mailing Address - Country:US
Mailing Address - Phone:317-278-9145
Mailing Address - Fax:317-278-0104
Practice Address - Street 1:550 UNIVERSITY BLVD
Practice Address - Street 2:#2405
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-278-9145
Practice Address - Fax:317-278-9145
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS