Provider Demographics
NPI:1699241026
Name:KELLEY, CORINA V (MSN, ANP)
Entity type:Individual
Prefix:
First Name:CORINA
Middle Name:V
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MSN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11201 SHAKER BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-3873
Mailing Address - Country:US
Mailing Address - Phone:216-791-0017
Mailing Address - Fax:216-791-0021
Practice Address - Street 1:11201 SHAKER BLVD STE 240
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-3873
Practice Address - Country:US
Practice Address - Phone:216-791-0017
Practice Address - Fax:216-791-0021
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023758363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner