Provider Demographics
NPI:1225167562
Name:BARRETT, KELLIE ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:ANN
Last Name:BARRETT
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 1:2027 ASPEN RUN RD
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-7901
Mailing Address - Country:US
Mailing Address - Phone:419-627-2593
Mailing Address - Fax:
Practice Address - Street 1:919 3RD ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3837
Practice Address - Country:US
Practice Address - Phone:419-624-8823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN068710164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse