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NPI Code Detail

MEDICARE: MS. PATRICIA A KELLY NMD, FNP-BC, GNPC-BC

MEDICARE: MS. PATRICIA A KELLY NMD, FNP-BC, GNPC-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerNP04543OH
2363LF0000XFamily Nurse Practitioner71000324AIN
3363LF0000XFamily Nurse PractitionerAPRN.CNP.04543OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000577056OTHEROHANTHEM
2421534506126OTHEROHCARESOURCE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164435582
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PATRICIA A KELLY NMD, FNP-BC, GNPC-BC
Provider Business Mailing Address
First Line : 3000 CORPORATE EXCHANGE DR
Second Line :
City : COLUMBUS
State : OH
Zip : 43231-7689
Country : US
Telephone Number : 888-528-5595
Fax Number : 562-528-5595
Provider Business Practice Location Address
First Line : 200 OCEANGATE STE 100
Second Line :
City : LONG BEACH
State : CA
Zip : 90802-4317
Country : US
Telephone Number : 888-562-5442
Fax Number : 562-528-5595
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2006
Last Update Date : 01/10/2018

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