Provider Demographics
NPI:1326752197
Name:KENNERLY, KELLE M
Entity Type:Individual
Prefix:
First Name:KELLE
Middle Name:M
Last Name:KENNERLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SAND RUN RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-6000
Mailing Address - Country:US
Mailing Address - Phone:330-475-3148
Mailing Address - Fax:
Practice Address - Street 1:140 SAND RUN RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-6000
Practice Address - Country:US
Practice Address - Phone:330-475-3148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver