Healthcare Provider Details

I. General information

NPI: 1043759459
Provider Name (Legal Business Name): KELLY FUSCO PMHNP BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W MARKET ST
AKRON OH
44303-1411
US

IV. Provider business mailing address

611 W MARKET ST
AKRON OH
44303-1411
US

V. Phone/Fax

Practice location:
  • Phone: 330-996-4600
  • Fax: 330-564-9296
Mailing address:
  • Phone: 330-996-4600
  • Fax: 330-564-9296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN355706
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRNCNP0027901
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: