Healthcare Provider Details

I. General information

NPI: 1558785535
Provider Name (Legal Business Name): PATRICIA KELLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 COLLEGE ST
POLAND OH
44514-2008
US

IV. Provider business mailing address

47 COLLEGE ST
POLAND OH
44514-2008
US

V. Phone/Fax

Practice location:
  • Phone: 330-757-7003
  • Fax:
Mailing address:
  • Phone: 330-757-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN.169224
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: