Provider Demographics
NPI:1427135110
Name:KUNKLER, KELLY J (RN,MSN,APRN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:KUNKLER
Suffix:
Gender:F
Credentials:RN,MSN,APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 MURLIN AVE
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-2459
Mailing Address - Country:US
Mailing Address - Phone:419-584-7111
Mailing Address - Fax:419-584-7112
Practice Address - Street 1:824 MURLIN AVE
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-2459
Practice Address - Country:US
Practice Address - Phone:419-584-7111
Practice Address - Fax:419-584-7112
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH259612163W00000X
OH08887363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGMedicaid
OHPENDINGMedicare ID - Type Unspecified
OHPENDINGMedicaid