Individual
MR. KYLE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
4350 CROCKER ROAD, STE 300, WESTLAKE, OH 44145-6329
(440) 558-8005
(440) 835-4790
Mailing address
2000 AUBURN DR., STE. 350, BEACHWOOD, OH 44122-4327
(440) 646-1600
(440) 646-1505
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.00763RX
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018527
—
OH
Enumeration date
12/30/2020
Last updated
10/28/2025
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