Healthcare Provider Details

I. General information

NPI: 1689589855
Provider Name (Legal Business Name): KELLY R NADAUD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 EASTLAND AVE SE
WARREN OH
44484-4503
US

IV. Provider business mailing address

4110 HERR FIELDHOUSE RD
SOUTHINGTON OH
44470-9583
US

V. Phone/Fax

Practice location:
  • Phone: 330-841-4029
  • Fax:
Mailing address:
  • Phone: 330-979-2694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0043070
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: