Healthcare Provider Details

I. General information

NPI: 1003985391
Provider Name (Legal Business Name): KELLY LEIGH SCHOLL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 GRAPHICS WAY STE 3100
LEWIS CENTER OH
43035-0238
US

IV. Provider business mailing address

940 MARION WILLIAMSPORT RD E
MARION OH
43302-8684
US

V. Phone/Fax

Practice location:
  • Phone: 740-428-0428
  • Fax: 740-909-4077
Mailing address:
  • Phone: 740-382-5781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number08935
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: