Healthcare Provider Details

I. General information

NPI: 1417860420
Provider Name (Legal Business Name): KELSEY CARROLL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 VALLEY VIEW DR
WAVERLY OH
45690-9135
US

IV. Provider business mailing address

8009 DENVER RD
WAVERLY OH
45690-9535
US

V. Phone/Fax

Practice location:
  • Phone: 740-947-8777
  • Fax:
Mailing address:
  • Phone: 740-289-2371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN404043
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: