Provider Demographics
NPI:1417629924
Name:KELLOGG, ALLISON (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 BUCKLES CT N STE 100
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6924
Mailing Address - Country:US
Mailing Address - Phone:614-237-0835
Mailing Address - Fax:614-237-1646
Practice Address - Street 1:680 BUCKLES CT N STE 100
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-6924
Practice Address - Country:US
Practice Address - Phone:614-237-0835
Practice Address - Fax:614-237-1646
Is Sole Proprietor?:No
Enumeration Date:2021-10-03
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0462676Medicaid