Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Nicole M. Kellner, PA

Individual provider Physician Assistant · NPI 1245581677

Nicole M. Kellner, PA is a Physician Assistant in Fort Wayne, Indiana. Qualified in 2012, 14 years ago. Practices with Lutheran Medical Group LLC, a 250-clinician group and accepts Medicare assignment. Licensed in Indiana.

Years since qualifying
14
Licensed in
IN
In the registry since
2012
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

7900 W Jefferson Blvd Ste 306
Fort Wayne, IN 46804-4128
Phone: (260) 479-3514
Fax: (260) 479-3520
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 10004106A (IN)

Record details

NPI number1245581677
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedSeptember 25, 2012
Last updated in NPPESAugust 14, 2024
Certification dateAugust 14, 2024
Mailing address6920 Pointe Inverness Way Ste 200, Fort Wayne, IN 46804-7934

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Lutheran Medical Group Llc — 250 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations10 on file with Medicare

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