Provider Demographics
NPI:1154525418
Name:COWDREY, KELLEY (RN)
Entity type:Individual
Prefix:MR
First Name:KELLEY
Middle Name:
Last Name:COWDREY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3036 PORTSMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1510
Mailing Address - Country:US
Mailing Address - Phone:513-871-0496
Mailing Address - Fax:
Practice Address - Street 1:3036 PORTSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-1510
Practice Address - Country:US
Practice Address - Phone:513-871-0496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH176481163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health