Individual
KATHLEEN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9000 N MAIN ST STE 232, ENGLEWOOD, OH 45415
(937) 277-8988
(937) 277-9035
Mailing address
3170 KETTERING BLVD BLDG B3, MORAINE, OH 45439-1924
(937) 991-3188
(937) 223-9811
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.004784RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0186637
—
OH
Enumeration date
09/22/2016
Last updated
01/20/2021
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