Healthcare Provider Details

I. General information

NPI: 1902277643
Provider Name (Legal Business Name): KELLY LYNN PEREZ C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY LYNN ROWLAND

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4875 HIGBEE AVE NW
CANTON OH
44718-2566
US

IV. Provider business mailing address

4875 HIGBEE AVE NW
CANTON OH
44718-2566
US

V. Phone/Fax

Practice location:
  • Phone: 330-492-3345
  • Fax: 330-491-9758
Mailing address:
  • Phone: 330-353-1808
  • Fax: 330-491-9758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.18134-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: