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General NPI Number Information
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NPI Number | 1104316793
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Entity Type | Individual
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Provider Name | KELLY M CHRISTEAN PA-C, MS
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Gender | Female
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 06/25/2023
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Provider Practice Location Address
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Address Line | 5901 E ROYALTON RD SUITE 1400B
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City | BROADVIEW HEIGHTS
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State | OH
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Zip | 44147
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Country | US
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Telephone | 440-499-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 5901 E ROYALTON RD SUITE 1400
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City | BROADVIEW HEIGHTS
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State | OH
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Zip | 44147
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Country | US
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Telephone | 440-499-5900
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 50.005507RX
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | OH
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