Healthcare Provider Details

I. General information

NPI: 1497061543
Provider Name (Legal Business Name): KELLY M KELMES CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2054 S GREEN RD
SOUTH EUCLID OH
44121-4243
US

IV. Provider business mailing address

2410 SAYBROOK RD
UNIVERSITY HEIGHTS OH
44118-3702
US

V. Phone/Fax

Practice location:
  • Phone: 216-291-9210
  • Fax:
Mailing address:
  • Phone: 330-635-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.11702-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.318401-COA1
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: