Provider Demographics
NPI:1073114369
Name:WARD, KELLYN RENA
Entity Type:Individual
Prefix:
First Name:KELLYN
Middle Name:RENA
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 VETERANS PKWY STE D&E
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-7152
Mailing Address - Country:US
Mailing Address - Phone:706-221-5253
Mailing Address - Fax:
Practice Address - Street 1:3518 VETERANS PKWY STE D&E
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-7152
Practice Address - Country:US
Practice Address - Phone:706-221-5253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician