Individual
KELBY ELIZABETH MIXELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
30 E APPLE STREET, SUITE 3300, DAYTON, OH 45409
(937) 208-8394
Mailing address
1005 DERRINGER DRIVE, ENGLEWOOD, OH 45322
(937) 694-8140
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.004469
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0144502
—
OH
01
—
1125596
NATIONAL CERTIFICATION OF PHYSICIAN ASSISTANT
OH
01
—
50.004469
OHIO CERTIFICATION TO PRACTICE- PHYSICIAN ASSISTANT
OH
Enumeration date
09/18/2015
Last updated
03/29/2024
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