Healthcare Provider Details

I. General information

NPI: 1275905036
Provider Name (Legal Business Name): KELLEY WHEATLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 TIMBER RIDGE TRL
STREETSBORO OH
44241-5888
US

IV. Provider business mailing address

2171 TIMBER RIDGE TRL
STREETSBORO OH
44241-5888
US

V. Phone/Fax

Practice location:
  • Phone: 216-483-5538
  • Fax:
Mailing address:
  • Phone: 216-483-5538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11002291
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.17501
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: