Provider Demographics
NPI:1083931257
Name:WHEELER, KELLI SUE (LPN)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:SUE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 WORTHINGTON CLUB DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4619
Mailing Address - Country:US
Mailing Address - Phone:614-288-5923
Mailing Address - Fax:
Practice Address - Street 1:6525 BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1789
Practice Address - Country:US
Practice Address - Phone:614-431-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 096855 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse