Individual
KELLY A SIEGEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
9485 MENTOR AVE, MENTOR, OH 44060-1716
(440) 255-5571
Mailing address
9485 MENTOR AVE SUITE 210, MENTOR, OH 44060
(440) 255-5571
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP-04339
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000224469
UNISON
OH
01
—
000000539712
ANTHEM
OH
05
—
2160683
—
OH
01
—
364120
WELLCARE
OH
01
—
7240712
AETNA
—
01
—
740018
BUCKEYE
OH
01
—
746018
BUCKEYE
OH
Enumeration date
07/16/2006
Last updated
03/01/2021
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