Provider Demographics
NPI:1538654744
Name:PEARL, KELLY (APRN CNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:PEARL
Suffix:
Gender:F
Credentials:APRN CNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:WARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN CNP
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3535 OLENTANGY RIVER RD FL 1
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3908
Practice Address - Country:US
Practice Address - Phone:614-566-4378
Practice Address - Fax:614-533-1216
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022949363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health