Provider Demographics
NPI:1992259485
Name:KELLY, ELIZABETH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1392 SUMMIT ST
Mailing Address - Street 2:APT C
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-2559
Mailing Address - Country:US
Mailing Address - Phone:614-517-9233
Mailing Address - Fax:
Practice Address - Street 1:1392 SUMMIT ST
Practice Address - Street 2:APT C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-2559
Practice Address - Country:US
Practice Address - Phone:614-517-9233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN418305163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse