Provider Demographics
NPI:1295135184
Name:CUDA, KELLI (NP)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:
Last Name:CUDA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:KELLI
Other - Middle Name:RENEE
Other - Last Name:CUDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:128 CHURCH CT
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7567
Mailing Address - Country:US
Mailing Address - Phone:614-202-9115
Mailing Address - Fax:
Practice Address - Street 1:5969 E BROAD ST STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1546
Practice Address - Country:US
Practice Address - Phone:614-864-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.16132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily