Healthcare Provider Details

I. General information

NPI: 1336968965
Provider Name (Legal Business Name): KELLIE M GARLING FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLIE M PURCELL

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ALLEN BRADLEY DR
MAYFIELD HEIGHTS OH
44124-6130
US

IV. Provider business mailing address

15280 OVERTURE DR
NEWBURY OH
44065-9595
US

V. Phone/Fax

Practice location:
  • Phone: 844-786-2355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0037733
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: