Healthcare Provider Details

I. General information

NPI: 1447026422
Provider Name (Legal Business Name): KELLY MARIE MARSH APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY MARIE MALM

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 STATE ROUTE 44 STE 203
ROOTSTOWN OH
44272-9733
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 330-325-3202
  • Fax: 833-606-1565
Mailing address:
  • Phone: 330-325-3202
  • Fax: 833-606-1565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0035164
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0035164
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: