Provider Demographics
NPI:1104316793
Name:CHRISTEAN, KELLY M (PA-C, MS)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:M
Last Name:CHRISTEAN
Suffix:
Gender:F
Credentials:PA-C, MS
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5901 E ROYALTON RD SUITE 1400
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147
Mailing Address - Country:US
Mailing Address - Phone:440-499-5900
Mailing Address - Fax:
Practice Address - Street 1:5901 E ROYALTON RD SUITE 1400B
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147
Practice Address - Country:US
Practice Address - Phone:440-499-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005507RX207P00000X
OH363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine