Provider Demographics
NPI:1013184076
Name:MEXICOTT, KELLY ANN (NURSE PRACTITIONER N)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:MEXICOTT
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CHILDRENS DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205
Mailing Address - Country:US
Mailing Address - Phone:614-722-6510
Mailing Address - Fax:614-722-4772
Practice Address - Street 1:3555 OLENTANGY RIVER ROAD
Practice Address - Street 2:NATIONWIDE CHILDRENS HOSPITAL AT RIVERSIDE METHODIST HO
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214
Practice Address - Country:US
Practice Address - Phone:614-566-5366
Practice Address - Fax:614-566-6675
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHMEX104280114363LN0005X
OHRN223475163W00000X
OHNP01142363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No163W00000XNursing Service ProvidersRegistered Nurse