Individual
BRENNAN L KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
3700 SOUTHERN BLVD STE 300, KETTERING, OH 45429-1226
(937) 643-9299
(937) 643-2343
Mailing address
3700 SOUTHERN BLVD STE 300, KETTERING, OH 45429-1226
(937) 643-9299
(937) 643-2343
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
50004106
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0110411
—
OH
Enumeration date
09/16/2014
Last updated
04/30/2025
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