Provider Demographics
NPI:1083221709
Name:KELL, JAMES MASON
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MASON
Last Name:KELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2661 NOTTINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-1121
Mailing Address - Country:US
Mailing Address - Phone:614-940-3480
Mailing Address - Fax:
Practice Address - Street 1:1030 HILO LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3627
Practice Address - Country:US
Practice Address - Phone:614-940-3481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0372474Medicaid