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General NPI Number Information
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NPI Number | 1467136218
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Entity Type | Individual
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Provider Name | GARRETT DAVID KELLOGG PA
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Gender | Male
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 6804 KINSMAN NICKERSON RD
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City | KINSMAN
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State | OH
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Zip | 44428-9511
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Country | US
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Telephone | 330-240-6436
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Fax |
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Provider Business Mailing Address
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Address Line | 6804 KINSMAN NICKERSON RD
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City | KINSMAN
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State | OH
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Zip | 44428-9511
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Country | US
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Telephone | 330-240-6436
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.008358RX
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License Number State | OH
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