Provider Demographics
NPI:1669813432
Name:KAUFFMAN, KELLEY (CNP, MSN)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:CNP, MSN
Other - Prefix:MISS
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MN
Mailing Address - Street 1:9378 LINDBERG DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-5502
Mailing Address - Country:US
Mailing Address - Phone:440-479-6442
Mailing Address - Fax:
Practice Address - Street 1:3929 ROCKY RIVER DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-4153
Practice Address - Country:US
Practice Address - Phone:216-252-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.372426-163W00000X
OHCOA.15794-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse