Provider Demographics
NPI:1174041149
Name:KELLY, YOLONDA M (NP)
Entity Type:Individual
Prefix:
First Name:YOLONDA
Middle Name:M
Last Name:KELLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 COMMONS BLVD. SUITE 160
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3834
Mailing Address - Country:US
Mailing Address - Phone:937-426-0049
Mailing Address - Fax:937-431-8140
Practice Address - Street 1:2510 COMMONS BLVD. SUITE 160
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3834
Practice Address - Country:US
Practice Address - Phone:937-426-0049
Practice Address - Fax:937-431-8140
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020993363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0362037Medicaid