Healthcare Provider Details

I. General information

NPI: 1306109566
Provider Name (Legal Business Name): PATRICIA A KELLEY HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA TURNER HIS

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 ROOSEVELT BLVD STE C
MIDDLETOWN OH
45044-6692
US

IV. Provider business mailing address

215 SHUMAN BLVD STE 401
NAPERVILLE IL
60563-8458
US

V. Phone/Fax

Practice location:
  • Phone: 513-424-7006
  • Fax: 513-785-4023
Mailing address:
  • Phone: 331-229-8208
  • Fax: 978-313-6824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number02829
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: