Healthcare Provider Details

I. General information

NPI: 1295171544
Provider Name (Legal Business Name): THE LITTLE CLINIC OF OHIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 E DOROTHY LN
KETTERING OH
45420
US

IV. Provider business mailing address

2620 ELM HILL PIKE
NASHVILLE TN
37214-3108
US

V. Phone/Fax

Practice location:
  • Phone: 937-610-9174
  • Fax:
Mailing address:
  • Phone: 615-425-4287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: THOMAS SHELLY
Title or Position: VP & GENERAL MANAGER
Credential:
Phone: 615-425-4200