Kelly D Colliflower, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

103705 Issued in OH

Practice address

8402 Blackjack Rd
Mount Vernon, OH 43050-9193

Phone

(740) 399-8022

NPI assigned

Oct 23, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Behavioral Healthcare Partners of Central Ohio Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Newark, OH
  • NPI 1063479079
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1083435861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8402 BLACKJACK RD",
            "city": "MOUNT VERNON",
            "state": "OH",
            "postal_code": "430509193",
            "telephone_number": "740-399-8022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8402 BLACKJACK RD",
            "city": "MOUNT VERNON",
            "state": "OH",
            "postal_code": "430509193",
            "telephone_number": "740-399-8022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLIFLOWER",
        "first_name": "KELLY",
        "middle_name": "D",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-23",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "103705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Clinedinst, DPT
• Mary Cochran
• Cole Vision Corporation
• Casey Cole
• Matheu L Coleman, LSW
• Colonial City Internal Medicine, Inc.
• Elizabeth Ann Combes, CDCA QMHS
• Community Medical Practices, LLC
• Tristin Nichole Compton, LCDCIII
• Concepts in Community Living, Inc.

• Licensed Practical Nurse in Mount Vernon, OH
• Providers in Mount Vernon, OH by specialty
• Licensed Practical Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.