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General NPI Number Information
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NPI Number | 1003332040
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Entity Type | Individual
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Provider Name | KELLY ANN LABRA FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/22/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 935 TRAILWOOD DR STE A
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-5062
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Country | US
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Telephone | 330-953-3204
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Fax | 330-953-3206
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Provider Business Mailing Address
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Address Line | 935 TRAILWOOD DR STE A
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-5062
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Country | US
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Telephone | 330-953-3204
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Fax | 330-953-3206
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.021539
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License Number State | OH
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