Healthcare Provider Details

I. General information

NPI: 1497601157
Provider Name (Legal Business Name): ANITA RAE KELLY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 BOND AVE
BARNESVILLE OH
43713-1281
US

IV. Provider business mailing address

611 BOND AVE
BARNESVILLE OH
43713-1281
US

V. Phone/Fax

Practice location:
  • Phone: 843-607-7234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number491086
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: