Healthcare Provider Details

I. General information

NPI: 1801522651
Provider Name (Legal Business Name): KERRY GILLETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

547 E 11TH AVE
COLUMBUS OH
43211-2603
US

IV. Provider business mailing address

547 E 11TH AVE
COLUMBUS OH
43211-2603
US

V. Phone/Fax

Practice location:
  • Phone: 614-224-4506
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0032530
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number307303
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: