Healthcare Provider Details

I. General information

NPI: 1922792118
Provider Name (Legal Business Name): KELLEY J HARNETT APRN.CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7623 MARKET ST
YOUNGSTOWN OH
44512-6054
US

IV. Provider business mailing address

100 DEBARTOLO PL STE 200
YOUNGSTOWN OH
44512-6095
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-5100
  • Fax: 330-965-5119
Mailing address:
  • Phone: 330-965-5100
  • Fax: 330-965-5119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0034016
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: