MEDICARE: KELLEE APPLEGATE

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
1	172A00000X	Driver

General Provider Information

NPI Number	:	1811719016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEE APPLEGATE

Provider Business Mailing Address
First Line	:	324 3RD AVE SW
Second Line	:
City	:	BEACH CITY
State	:	OH
Zip	:	44608-9557
Country	:	US
Telephone Number	:	765-717-9309
Fax Number	:

Provider Business Practice Location Address
First Line	:	324 3RD AVE SW
Second Line	:
City	:	BEACH CITY
State	:	OH
Zip	:	44608-9557
Country	:	US
Telephone Number	:	765-717-9309
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	10/29/2024

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Directions to “ KELLEE APPLEGATE ” Practice Location

Language	Start Address	Practice Location

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