Individual
KELLY O'CONNOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7232 JUSTIN WAY, MENTOR, OH 44060-4881
(440) 578-8200
Mailing address
7232 JUSTIN WAY, MENTOR, OH 44060-4881
(440) 578-8200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.004693RX
OH
363A00000X
Physician Assistant
MA005820
PA
363A00000X
Physician Assistant
OA002943
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0186430
—
OH
Enumeration date
11/21/2012
Last updated
02/09/2021
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