Provider Demographics
NPI:1326454299
Name:GOARE, KELLIE JEAN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:JEAN
Last Name:GOARE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:KELLIE
Other - Middle Name:JEAN
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8177 LAKE BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4670
Mailing Address - Country:US
Mailing Address - Phone:614-560-6785
Mailing Address - Fax:
Practice Address - Street 1:918 HIGH ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4110
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.16183-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily