Provider Demographics
NPI:1952592735
Name:KELLY, JAMES GERARD (LPN)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GERARD
Last Name:KELLY
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 LOPERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:OH
Mailing Address - Zip Code:44050-9756
Mailing Address - Country:US
Mailing Address - Phone:440-506-1661
Mailing Address - Fax:
Practice Address - Street 1:120 LOPERWOOD LN
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:OH
Practice Address - Zip Code:44050-9756
Practice Address - Country:US
Practice Address - Phone:440-506-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH119519164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse