Healthcare Provider Details

I. General information

NPI: 1780964718
Provider Name (Legal Business Name): LISBETH KELLEY-MATTHEWS BSN,RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4196 TIMES SQUARE BLVD
DUBLIN OH
43016-7101
US

IV. Provider business mailing address

4196 TIMES SQUARE BLVD
DUBLIN OH
43016-7101
US

V. Phone/Fax

Practice location:
  • Phone: 614-353-5214
  • Fax: 614-754-5086
Mailing address:
  • Phone: 614-353-5214
  • Fax: 614-754-5086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number258508
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: