Provider Demographics
NPI:1144761057
Name:PRATHER, KELLY L (FNP-BC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:PRATHER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:1199 HADLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1788
Practice Address - Country:US
Practice Address - Phone:317-834-3263
Practice Address - Fax:317-834-5194
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2023-05-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71001368A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner