Provider Demographics
NPI:1003927138
Name:NAGEL, KELLY L (FNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:NAGEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 CORPORATE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-1167
Mailing Address - Country:US
Mailing Address - Phone:937-898-2097
Mailing Address - Fax:
Practice Address - Street 1:505 CORPORATE CENTER DR
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-1167
Practice Address - Country:US
Practice Address - Phone:937-898-2097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2479643Medicaid
OH2479643Medicaid
OHQ00006Medicare UPIN