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General NPI Number Information
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NPI Number | 1487193132
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Entity Type | Individual
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Provider Name | KELLY KRIKLAVA P.A.
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Gender | Female
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Dates
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Enumeration Date | 02/14/2017
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 3333 BURNET AVE, ML 1013
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City | CINCINNATI
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State | OH
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Zip | 45229
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Country | US
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Telephone | 513-636-4466
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Fax | 513-636-5846
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Provider Business Mailing Address
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Address Line | PO BOX 417
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City | STUART
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State | FL
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Zip | 34995-0417
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Country | US
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Telephone | 772-781-2799
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Fax | 772-781-2716
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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 | C0006386
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License Number State | MD
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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 | PA9111155
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 4542
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.007959RX
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License Number State | OH
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