Provider Demographics
NPI:1275206039
Name:BRILL, KELLY D (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:D
Last Name:BRILL
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 CROCKER PARK BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-8147
Mailing Address - Country:US
Mailing Address - Phone:440-864-2802
Mailing Address - Fax:440-287-6137
Practice Address - Street 1:159 CROCKER PARK BLVD STE 400
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-8147
Practice Address - Country:US
Practice Address - Phone:440-864-2802
Practice Address - Fax:440-287-6137
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.384208163W00000X
OHAPRN.CNP.0031831363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse