Provider Demographics
NPI:1376058701
Name:KELLIS, MELISSA ANN (CNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:KELLIS
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 1:2200 JEFFERSON AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7102
Mailing Address - Country:US
Mailing Address - Phone:419-251-2032
Mailing Address - Fax:
Practice Address - Street 1:100 W MCCREIGHT AVE STE 150
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1890
Practice Address - Country:US
Practice Address - Phone:937-323-1404
Practice Address - Fax:937-323-1407
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRNCNP021736363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner