Provider Demographics
NPI:1679448732
Name:EKBERG, KELLY ELIZABETH
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ELIZABETH
Last Name:EKBERG
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 1:8809B CINCINNATI DAYTON RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-3134
Mailing Address - Country:US
Mailing Address - Phone:513-360-8205
Mailing Address - Fax:513-620-6545
Practice Address - Street 1:8809B CINCINNATI DAYTON RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3134
Practice Address - Country:US
Practice Address - Phone:513-360-8205
Practice Address - Fax:513-620-6545
Is Sole Proprietor?:No
Enumeration Date:2025-10-08
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2504665-TRNE390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program