Provider Demographics
NPI:1568551398
Name:KELLEY, DENNIS MICHAEL (RN NP)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:MICHAEL
Last Name:KELLEY
Suffix:
Gender:M
Credentials:RN NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10701 EAST BLVD
Mailing Address - Street 2:LOUIS STOKES CLEVELAND VA MEDICAL CENTER
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1702
Mailing Address - Country:US
Mailing Address - Phone:216-791-3800
Mailing Address - Fax:216-707-5959
Practice Address - Street 1:26600 NORMANDY RD
Practice Address - Street 2:
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140-2318
Practice Address - Country:US
Practice Address - Phone:440-835-8540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 00187363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health