Provider Demographics
NPI:1942079736
Name:EDWARDS, KELCEY RYAN (LPN)
Entity Type:Individual
Prefix:
First Name:KELCEY
Middle Name:RYAN
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8315 STATE ROUTE 179
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44638-9704
Mailing Address - Country:US
Mailing Address - Phone:330-988-4283
Mailing Address - Fax:
Practice Address - Street 1:1700 E SMITHVILLE WESTERN RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1010
Practice Address - Country:US
Practice Address - Phone:330-601-1001
Practice Address - Fax:330-345-0001
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5230434164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse