Individual
KELLEY PRUIETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
2109 HUGHES DR # 720, TOLEDO, OH 43606-3858
(419) 291-2077
(419) 291-2122
Mailing address
2109 HUGHES DR # 720, TOLEDO, OH 43606-3858
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN-276458
OH
363L00000X
Nurse Practitioner
Primary
APRN.CNP.11612
OH
363L00000X
Nurse Practitioner
Primary
NP-11612
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000671121
ANTHEM
OH
05
—
3076442
—
OH
01
—
9384591
AETNA
OH
01
—
P00962317
RRMC
OH
Enumeration date
07/26/2010
Last updated
03/09/2026
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