Provider Demographics
NPI:1942812193
Name:VAN ATTA, KELLEY LYNN (CNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:LYNN
Last Name:VAN ATTA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MISS
Other - First Name:KELLEY
Other - Middle Name:LYNN
Other - Last Name:SALSBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-1214
Mailing Address - Country:US
Mailing Address - Phone:419-423-5221
Mailing Address - Fax:419-423-5143
Practice Address - Street 1:1900 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1216
Practice Address - Country:US
Practice Address - Phone:419-423-5221
Practice Address - Fax:419-423-5143
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0027390363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care