Provider Demographics
NPI:1689187478
Name:MOREHOUSE, KELLY LEE (LPN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LEE
Last Name:MOREHOUSE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S WENTZ ST
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-1719
Mailing Address - Country:US
Mailing Address - Phone:419-236-9350
Mailing Address - Fax:
Practice Address - Street 1:2727 SAINT JOHNS RD STE D
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-4029
Practice Address - Country:US
Practice Address - Phone:567-940-9145
Practice Address - Fax:567-940-9803
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.157557.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse