Healthcare Provider Details

I. General information

NPI: 1417840430
Provider Name (Legal Business Name): KALLI JOELLE UNDERWOOD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KALLI JOELLE HOLLAND

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 DUBLIN RD STE 100
COLUMBUS OH
43215-1025
US

IV. Provider business mailing address

8444 N 90TH ST STE 100
SCOTTSDALE AZ
85258-4437
US

V. Phone/Fax

Practice location:
  • Phone: 614-488-7117
  • Fax: 614-488-7118
Mailing address:
  • Phone: 602-248-8886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4945502
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: