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General NPI Number Information
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NPI Number | 1265267645
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Entity Type | Individual
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Provider Name | SUE ANNE MARIE KELLY FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/04/2024
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 4879 US HIGHWAY 68 S
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City | WEST LIBERTY
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State | OH
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Zip | 43357-9525
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Country | US
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Telephone | 937-599-1411
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Fax |
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Provider Business Mailing Address
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Address Line | 1391 COUNTY ROAD 5 N
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City | ZANESFIELD
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State | OH
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Zip | 43360-9747
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Country | US
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Telephone | 937-407-3330
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRNCNP-0036950
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License Number State | OH
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