Provider Demographics
NPI:1548257637
Name:GOLLAR, KELLY M (APRN)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:M
Last Name:GOLLAR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HOSPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3769
Mailing Address - Country:US
Mailing Address - Phone:812-282-3899
Mailing Address - Fax:812-282-4173
Practice Address - Street 1:101 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3769
Practice Address - Country:US
Practice Address - Phone:812-282-3899
Practice Address - Fax:812-282-4173
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2025-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003340363LA2200X, 363L00000X
IN71001005A363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY500015602OtherRR MCR
IN200289980Medicaid
IN500015603OtherRR MCR
KY78004702Medicaid
P18664Medicare UPIN
P18664Medicare UPIN
KY1165008Medicare ID - Type Unspecified