Provider Demographics
NPI:1518379130
Name:ELDER, KELLY LYNN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LYNN
Last Name:ELDER
Suffix:
Gender:F
Credentials:FNP-C
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Mailing Address - Street 1:801 MACARTHUR BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2919
Mailing Address - Country:US
Mailing Address - Phone:219-836-7713
Mailing Address - Fax:219-836-7083
Practice Address - Street 1:929 E COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-2307
Practice Address - Country:US
Practice Address - Phone:219-233-5400
Practice Address - Fax:219-292-4100
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2025-05-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71005229A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300095489Medicaid
IN1102355858OtherANTHEM