Healthcare Provider Details

I. General information

NPI: 1801785191
Provider Name (Legal Business Name): COURTNEY KEHR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7590 AUBURN RD
CONCORD TOWNSHIP OH
44077-9176
US

IV. Provider business mailing address

11900 EDGEWATER DR APT 1108
LAKEWOOD OH
44107-1764
US

V. Phone/Fax

Practice location:
  • Phone: 440-375-8100
  • Fax:
Mailing address:
  • Phone: 440-867-1988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: