Provider Demographics
NPI:1013704477
Name:KELLY, TAURI LYNN (LPN)
Entity type:Individual
Prefix:
First Name:TAURI
Middle Name:LYNN
Last Name:KELLY
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 STATE RD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6208
Mailing Address - Country:US
Mailing Address - Phone:440-812-8194
Mailing Address - Fax:
Practice Address - Street 1:4510 STATE RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6208
Practice Address - Country:US
Practice Address - Phone:440-812-8194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH169293.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse