Provider Demographics
NPI:1225698640
Name:MOTHERWELL, KELLI A (AGPCNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:A
Last Name:MOTHERWELL
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-9769
Mailing Address - Country:US
Mailing Address - Phone:330-398-3388
Mailing Address - Fax:
Practice Address - Street 1:1390 S ARCH AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4111
Practice Address - Country:US
Practice Address - Phone:330-821-3961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.333481163W00000X
OHAPRN.CNP.024862363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse