Provider Demographics
NPI:1649047341
Name:KELLOM, MARKECHIA
Entity type:Individual
Prefix:
First Name:MARKECHIA
Middle Name:
Last Name:KELLOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 CATLIN DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2529
Mailing Address - Country:US
Mailing Address - Phone:216-423-8349
Mailing Address - Fax:
Practice Address - Street 1:485 CATLIN DR
Practice Address - Street 2:
Practice Address - City:RICHMOND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2529
Practice Address - Country:US
Practice Address - Phone:216-423-8349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide