Individual
KELLY WAYT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1965 NEWARK GRANVILLE RD, GRANVILLE, OH 43023-9171
(740) 973-1394
Mailing address
160 VAN TASSELL AVE, NEWARK, OH 43055-3082
(740) 973-1394
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
APRN.CNP.0028110
OH
363L00000X
Nurse Practitioner
Primary
APRN.CNP.0028110
OH
Other
Enumeration date
01/14/2021
Last updated
10/14/2024
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