Provider Demographics
NPI:1003985391
Name:SCHOLL, KELLY LEIGH (CNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LEIGH
Last Name:SCHOLL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 MARION WILLIAMSPORT RD E
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-8684
Mailing Address - Country:US
Mailing Address - Phone:740-382-5781
Mailing Address - Fax:
Practice Address - Street 1:940 MARION WILLIAMSPORT RD E
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-8684
Practice Address - Country:US
Practice Address - Phone:740-382-5781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08935363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health