Provider Demographics
NPI:1982160420
Name:ADAMCZYK, KELLY MARIE (CNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:ADAMCZYK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:GERBASI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4694 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1012
Mailing Address - Country:US
Mailing Address - Phone:330-480-7655
Mailing Address - Fax:330-759-3851
Practice Address - Street 1:3455 MILL RUN DR STE 310
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-9082
Practice Address - Country:US
Practice Address - Phone:833-358-2036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily