Provider Demographics
NPI:1891091062
Name:RISER, KELLI SUZANNE (CNP)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:SUZANNE
Last Name:RISER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:MCNAMARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4335 ALUM CREEK DR STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-4520
Practice Address - Country:US
Practice Address - Phone:614-788-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.287692-COA1163W00000X
OHCOA.11248-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0052635Medicaid
OHH009781Medicare PIN
OH0052635Medicaid