Healthcare Provider Details

I. General information

NPI: 1669813432
Provider Name (Legal Business Name): KELLEY KAUFFMAN CNP, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLEY BLAKE RN, MN

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 ROCKY RIVER DR
CLEVELAND OH
44111-4153
US

IV. Provider business mailing address

9378 LINDBERG DR
NORTH ROYALTON OH
44133-5502
US

V. Phone/Fax

Practice location:
  • Phone: 216-252-5800
  • Fax:
Mailing address:
  • Phone: 440-479-6442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCOA.15794-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.372426-
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: