Healthcare Provider Details

I. General information

NPI: 1457612442
Provider Name (Legal Business Name): CORTNEE JANAE KELLY ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BELMONT AVE
YOUNGSTOWN OH
44504-1003
US

IV. Provider business mailing address

1001 BELMONT AVE
YOUNGSTOWN OH
44504-1003
US

V. Phone/Fax

Practice location:
  • Phone: 330-747-6446
  • Fax: 330-747-6843
Mailing address:
  • Phone: 330-747-6446
  • Fax: 330-747-6843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4045629
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN358987
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.13869
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCOA 13869- NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: