Provider Demographics
NPI:1437283041
Name:KELLEY, BECKY ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:ANN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 TOWNSHIP. RD. 247
Mailing Address - Street 2:
Mailing Address - City:KITTS HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45645
Mailing Address - Country:US
Mailing Address - Phone:740-643-0935
Mailing Address - Fax:740-643-0935
Practice Address - Street 1:485 TOWNSHIP ROAD 247
Practice Address - Street 2:
Practice Address - City:KITTS HILL
Practice Address - State:OH
Practice Address - Zip Code:45645-8808
Practice Address - Country:US
Practice Address - Phone:740-643-0935
Practice Address - Fax:740-643-0935
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-095577164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse