Provider Demographics
NPI:1720765233
Name:STRAUB, KELLY MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:STRAUB
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 80690
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-0690
Mailing Address - Country:US
Mailing Address - Phone:330-363-7444
Mailing Address - Fax:330-363-7770
Practice Address - Street 1:PO BOX 80690
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-0690
Practice Address - Country:US
Practice Address - Phone:330-363-7444
Practice Address - Fax:330-363-7770
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH50.009319RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant