Healthcare Provider Details

I. General information

NPI: 1457988594
Provider Name (Legal Business Name): COURTNEY ALEXANDRA KELLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 W BOWERY ST
AKRON OH
44308-1046
US

IV. Provider business mailing address

201 W FEDERAL ST APT 404
YOUNGSTOWN OH
44503-1221
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-8040
  • Fax:
Mailing address:
  • Phone: 317-417-6227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number35.156927
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301509716
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: