Provider Demographics
NPI:1235411869
Name:SKELLY, CHRISTY L (CRNP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:L
Last Name:SKELLY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:CHRISTY
Other - Middle Name:L
Other - Last Name:PESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5000 HIGBEE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2522
Mailing Address - Country:US
Mailing Address - Phone:330-493-0313
Mailing Address - Fax:330-493-3643
Practice Address - Street 1:5000 HIGBEE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2522
Practice Address - Country:US
Practice Address - Phone:330-493-0313
Practice Address - Fax:330-493-3643
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA-08365-NP363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCOA-08365-NPOtherOHIO LICENSE