Individual
IESHA THERESA KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
5711 HARRISON AVE, MAPLE HEIGHTS, OH 44137-3332
(216) 415-2150
Mailing address
22501 LAKEMONT AVE, EUCLID, OH 44123-1623
(216) 704-8696
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN.185135
OH
251J00000X
Nursing Care Agency
6724
OH
376K00000X
Nurse's Aide
6724
OH
Other
Enumeration date
03/11/2021
Last updated
03/29/2025
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