Healthcare Provider Details

I. General information

NPI: 1437073848
Provider Name (Legal Business Name): KELLY KOESTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 WATKINS RD
COLUMBUS OH
43207-3320
US

IV. Provider business mailing address

157 OLDE MOUND LN
PICKERINGTON OH
43147-1444
US

V. Phone/Fax

Practice location:
  • Phone: 614-365-6411
  • Fax:
Mailing address:
  • Phone: 614-530-7928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number223086
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: