Provider Demographics
NPI:1639362916
Name:KELLY, PATRICIA (CNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7580 AUBURN RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9615
Mailing Address - Country:US
Mailing Address - Phone:440-352-0400
Mailing Address - Fax:440-352-4535
Practice Address - Street 1:7580 AUBURN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-9615
Practice Address - Country:US
Practice Address - Phone:440-352-0400
Practice Address - Fax:440-352-4535
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH144814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily