Healthcare Provider Details

I. General information

NPI: 1467810200
Provider Name (Legal Business Name): LINDSAY ANN KELLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 27TH ST
PORTSMOUTH OH
45662-2640
US

IV. Provider business mailing address

1735 27TH ST STE B06
PORTSMOUTH OH
45662-2681
US

V. Phone/Fax

Practice location:
  • Phone: 740-356-2567
  • Fax: 740-356-2509
Mailing address:
  • Phone: 740-356-8034
  • Fax: 740-353-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.18749
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: