Provider Demographics
NPI:1629541370
Name:LA MAGNA, KELLY MARIE (CPNP-AC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:LA MAGNA
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:EBERHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 E 7TH AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-2593
Mailing Address - Country:US
Mailing Address - Phone:440-309-7056
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-05
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024039363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care