Provider Demographics
NPI:1063212041
Name:SIPE, KELLY A
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:SIPE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1283 TOWNSHIP ROAD 1706
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-9451
Mailing Address - Country:US
Mailing Address - Phone:330-201-3778
Mailing Address - Fax:
Practice Address - Street 1:1283 TOWNSHIP ROAD 1706
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-9451
Practice Address - Country:US
Practice Address - Phone:330-201-3778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker