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General NPI Number Information
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NPI Number | 1215585237
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Entity Type | Individual
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Provider Name | KELSEY ELIZABETH BODELL P.A.
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Gender | Female
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Dates
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Enumeration Date | 09/03/2019
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 6150 PARK SQUARE DR STE B
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City | LORAIN
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State | OH
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Zip | 44053-4153
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Country | US
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Telephone | 440-984-6499
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Fax | 234-757-7545
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Provider Business Mailing Address
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Address Line | 2000 AUBURN DR STE 350
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City | BEACHWOOD
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State | OH
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Zip | 44122-4327
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Country | US
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Telephone | 440-646-1600
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Fax | 440-646-1505
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA13347
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.009589RX
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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