Healthcare Provider Details

I. General information

NPI: 1427558568
Provider Name (Legal Business Name): KELLY ELIZABETH FERIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 07/17/2023
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OLD STATION RD APT 2106
CRANBERRY TOWNSHIP PA
16066-1812
US

IV. Provider business mailing address

11687 SHAGBARK TRL
STRONGSVILLE OH
44149-8537
US

V. Phone/Fax

Practice location:
  • Phone: 440-724-5097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT007354
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: