Provider Demographics
NPI:1467549279
Name:POPOVICH, KEHLLEE L (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:KEHLLEE
Middle Name:L
Last Name:POPOVICH
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1716
Mailing Address - Country:US
Mailing Address - Phone:216-286-9594
Mailing Address - Fax:216-201-4654
Practice Address - Street 1:11100 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-5006
Practice Address - Country:US
Practice Address - Phone:216-286-9594
Practice Address - Fax:216-201-4654
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNP-03798363LA2100X
OHRN226660COA1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care