Provider Demographics
NPI:1063127421
Name:KELLUM, RYAN SR
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:KELLUM
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 GAHL TER APT C
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-3642
Mailing Address - Country:US
Mailing Address - Phone:513-328-4209
Mailing Address - Fax:
Practice Address - Street 1:52 GAHL TER APT C
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-3642
Practice Address - Country:US
Practice Address - Phone:513-328-4209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health