Healthcare Provider Details

I. General information

NPI: 1235350851
Provider Name (Legal Business Name): KELLI JO ADAMS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1168 PLYMOUTH EAST RD.
PLYMOUTH OH
44865-9671
US

IV. Provider business mailing address

1168 PLYMOUTH EAST RD.
PLYMOUTH OH
44865
US

V. Phone/Fax

Practice location:
  • Phone: 419-687-4304
  • Fax:
Mailing address:
  • Phone: 419-687-4304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN 109475
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: