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NPI Code Detail

MEDICARE: KELLY RUSSELL RN

MEDICARE: KELLY RUSSELL RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WP0808XPsychiatric/Mental Health Registered NurseRN.412637OH

General Provider Information

NPI Number : 1548773625
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY RUSSELL RN
Provider Business Mailing Address
First Line : 5982 RHODES RD
Second Line :
City : KENT
State : OH
Zip : 44240-8100
Country : US
Telephone Number : 330-673-1347
Fax Number :
Provider Business Practice Location Address
First Line : 5982 RHODES RD
Second Line :
City : KENT
State : OH
Zip : 44240-8100
Country : US
Telephone Number : 330-673-1347
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2017
Last Update Date : 04/28/2026

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