Provider Demographics
NPI:1912597279
Name:KEIL, KORTNI ANN (FNP-C)
Entity type:Individual
Prefix:
First Name:KORTNI
Middle Name:ANN
Last Name:KEIL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KORTNI
Other - Middle Name:ANN
Other - Last Name:DYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:151 N DELAWARE ST STE 520
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-2535
Mailing Address - Country:US
Mailing Address - Phone:317-247-9151
Mailing Address - Fax:317-247-9159
Practice Address - Street 1:1001 N WESTERN AVE STE D
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2567
Practice Address - Country:US
Practice Address - Phone:765-573-6414
Practice Address - Fax:765-573-6426
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28222061A163W00000X
INF07201642363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse