Provider Demographics
NPI:1811697998
Name:KELLUMS, VICKI MARIE (RN)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:MARIE
Last Name:KELLUMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:MARIE
Other - Last Name:MALIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:433 E HILLSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:SEVEN HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2454
Mailing Address - Country:US
Mailing Address - Phone:440-477-6553
Mailing Address - Fax:
Practice Address - Street 1:6780 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2294
Practice Address - Country:US
Practice Address - Phone:440-312-3145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.382686163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse