Provider Demographics
NPI:1174850572
Name:BOROFF-PRAUL, KELLY ANN (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:BOROFF-PRAUL
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:BOROFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:855-255-0550
Mailing Address - Fax:614-366-4224
Practice Address - Street 1:480 MEDICAL CENTER DR FL 1
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1229
Practice Address - Country:US
Practice Address - Phone:855-255-0550
Practice Address - Fax:614-366-4224
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020807363LF0000X, 363LF0000X
OHAPRN.CNP.09964363LF0000X
OHNP09964363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care