Provider Demographics
NPI:1760502504
Name:DYER, KELLEY DAWN (CNM)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:DAWN
Last Name:DYER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 DOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2305
Mailing Address - Country:US
Mailing Address - Phone:937-599-3538
Mailing Address - Fax:937-599-4712
Practice Address - Street 1:110 DOWELL AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2305
Practice Address - Country:US
Practice Address - Phone:937-599-3538
Practice Address - Fax:937-599-4712
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNM07070367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2440835Medicaid
ME0505092Medicare ID - Type Unspecified
OHC02210Medicare UPIN
OH2440835Medicaid