Individual
KELLY COY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2400 LAKEVIEW DR STE 100, BEAVERCREEK, OH 45431-2581
(937) 429-4369
(937) 429-4575
Mailing address
3170 KETTERING BLVD BLDG B, MORAINE, OH 45439-1924
(937) 991-3188
(937) 223-9811
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.005656RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0307792
—
OH
Enumeration date
08/03/2018
Last updated
03/01/2022
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