Healthcare Provider Details

I. General information

NPI: 1639858913
Provider Name (Legal Business Name): KELSEY CASANO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 BOETTLER RD STE 100
UNIONTOWN OH
44685-7793
US

IV. Provider business mailing address

PO BOX 932909
CLEVELAND OH
44193-0026
US

V. Phone/Fax

Practice location:
  • Phone: 330-896-0009
  • Fax: 330-896-0032
Mailing address:
  • Phone: 330-854-4281
  • Fax: 330-854-4281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.0034396
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.0034396
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN.CNP.0034396
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: