Provider Demographics
NPI:1184029894
Name:KELLEY, JODI MELINDA (CNP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:MELINDA
Last Name:KELLEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 YANKEE RD
Mailing Address - Street 2:ML 16026
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-3500
Mailing Address - Country:US
Mailing Address - Phone:513-803-9600
Mailing Address - Fax:513-803-9659
Practice Address - Street 1:7777 YANKEE RD
Practice Address - Street 2:ML 16026
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-3500
Practice Address - Country:US
Practice Address - Phone:513-803-9600
Practice Address - Fax:513-803-9659
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.15155-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics