Provider Demographics
NPI:1699246413
Name:CANALE, KELLEY A (CNP)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:A
Last Name:CANALE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 PURCELL ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-3551
Mailing Address - Country:US
Mailing Address - Phone:303-659-9700
Mailing Address - Fax:720-336-3989
Practice Address - Street 1:5801 TAMARACK BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3747
Practice Address - Country:US
Practice Address - Phone:614-436-6009
Practice Address - Fax:614-436-6361
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023876363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty