Provider Demographics
NPI:1215474853
Name:DIRUTIGLIANO, KELSEY JEANNE (PA)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:JEANNE
Last Name:DIRUTIGLIANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:KELSEY
Other - Middle Name:JEANNE
Other - Last Name:GRAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 EAST BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1015
Mailing Address - Country:US
Mailing Address - Phone:614-252-8300
Mailing Address - Fax:614-252-6637
Practice Address - Street 1:800 EAST BROAD STREET
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1015
Practice Address - Country:US
Practice Address - Phone:614-252-8300
Practice Address - Fax:614-252-6637
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004940RX363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0223382Medicaid