Healthcare Provider Details

I. General information

NPI: 1316851991
Provider Name (Legal Business Name): KELSEY SQUIRES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2724 MARINER AVE
YOUNGSTOWN OH
44505-4208
US

IV. Provider business mailing address

2724 MARINER AVE
YOUNGSTOWN OH
44505-4208
US

V. Phone/Fax

Practice location:
  • Phone: 330-744-7823
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberLPN.189395
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: