Healthcare Provider Details

I. General information

NPI: 1407255193
Provider Name (Legal Business Name): KAYLA LUCARELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 GUERNSEY ST
BELLAIRE OH
43906-1540
US

IV. Provider business mailing address

3902 OLIVE AVE
SHADYSIDE OH
43947-1139
US

V. Phone/Fax

Practice location:
  • Phone: 740-359-4439
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberOH3191208
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberAPRN90234
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number024485
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: