Healthcare Provider Details

I. General information

NPI: 1427336767
Provider Name (Legal Business Name): KELLY LYNN MCGRANAHAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY LYNN MALENSEK

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E MARKET ST STE. 3-E
AKRON OH
44304-1619
US

IV. Provider business mailing address

525 E MARKET ST STE. 3-E
AKRON OH
44304-1619
US

V. Phone/Fax

Practice location:
  • Phone: 330-379-5100
  • Fax: 330-379-5177
Mailing address:
  • Phone: 330-379-5100
  • Fax: 330-379-5177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCOA.12526-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: