Provider Demographics
NPI:1154728905
Name:NEWELL, KELLY (RDH/CHE)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:NEWELL
Suffix:
Gender:F
Credentials:RDH/CHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 CHEATWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WELLSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45692
Mailing Address - Country:US
Mailing Address - Phone:740-384-0624
Mailing Address - Fax:
Practice Address - Street 1:519 CHEATWOOD RD
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:OH
Practice Address - Zip Code:45692
Practice Address - Country:US
Practice Address - Phone:740-384-0624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH31007212174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator