Healthcare Provider Details

I. General information

NPI: 1205307618
Provider Name (Legal Business Name): KELLIE RENEE VEGH CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 S TRIMBLE RD
MANSFIELD OH
44906-3437
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 419-774-0478
  • Fax: 419-774-0125
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.023946
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: