NPIMap

Individual provider Active NPI

Kelley Pruiett, CNP

  • Nurse Practitioner
  • Toledo, OH
National Provider Identifier
1649583139
Registry record updated Mar 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN.CNP.11612 Issued in OH
Practice address
2109 Hughes Dr # 720
Toledo, OH 43606-3858
Phone
(419) 291-2077
Fax
(419) 291-2122
NPI assigned
Jul 26, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X APRN.CNP.11612 OH Primary
Registered Nurse 163W00000X RN-276458 OH

Addresses

Primary practice location

2109 Hughes Dr # 720
Toledo, OH 43606-3858

Mailing address

2109 Hughes Dr # 720
Toledo, OH 43606-3858

Other identifiers 4

IdentifierTypeStateIssuer
9384591OtherOHAETNA
P00962317OtherOHRRMC
000000671121OtherOHANTHEM
3076442MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kpruiett14139@epicdirect.promedica.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, MI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20101006001189 OH Practitioner - Nurse Practitioner 3971795113 Reassigns benefits to 4 organizations
I20251006002326 MI Practitioner - Nurse Practitioner 3971795113 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Medical College of Ohio, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promedica Central PhysiciansGroup PAC ID 2365348190, 785 clinicians
The Toledo HospitalGroup PAC ID 2961309638, 118 clinicians
Bay Park Community HospitalGroup PAC ID 1951200872, 18 clinicians

Practice addresses (Care Compare)

2121 Hughes Dr
Suite 710
Toledo, OH 43606-5131
Phone (419) 291-2671

2142 N Cove Blvd
Toledo, OH 43606-3895
Phone (419) 291-4000

2801 Bay Park Dr
Oregon, OH 43616-4920
Phone (419) 690-7900

2940 N McCord Rd
Toledo, OH 43615-1753
Phone (419) 842-3000

905 N Macomb St
Suite 2
Monroe, MI 48162-3084
Phone (734) 242-1899

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN-276458OHMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Consultants in Laboratory Medicine of Greater Toledo Current Accepting new patients
Promedica Northwest Ohio Cardiology Consultants, LLC CurrentSince Jan 1, 2013 Accepting new patients
Mercy Memorial Hospital Corporation CurrentSince Jul 31, 2025 Accepting new patients
The Toledo Hospital CurrentSince Jul 31, 2025 Accepting new patients
The Toledo Hospital CurrentSince Jul 31, 2025 Accepting new patients
Bay Park Community Hospital CurrentSince Jul 31, 2025 Accepting new patients
The Toledo Hospital Current Accepting new patients
Promedica Northwest Ohio Cardiology Consultants, LLC CurrentSince Jan 1, 2013 Accepting new patients
Mercy Memorial Hospital Corporatio CurrentSince Jul 31, 2025 Accepting new patients
Haematology-Oncology Associates of Ohio and Michigan PC Current Accepting new patients
Midwest Cardiovascular Consultants LLC Past Accepting new patients
Bay Park Community Hospital Past Accepting new patients

Locations

905 N Macomb St
Ste 2
Monroe, MI 48162
Phone (734) 242-1899

718 N Macomb St
Monroe, MI 48162
Phone (734) 212-3097

715 S Taft Ave
Fremont, OH 43420
Phone (419) 332-7321

5901 Monclova Rd
Maumee, OH 43537
Phone (419) 893-5911

2801 Bay Park Dr
Oregon, OH 43616
Phone (419) 690-7652

1601 Brigham Dr
Ste 120
Perrysburg, OH 43551
Phone (419) 872-7703

2121 Hughes Dr
Ste 710
Toledo, OH 43606
Phone (419) 291-2610

2109 Hughes Dr
#720
Toledo, OH 43606
Phone (419) 291-2077

2142 N Cove Blvd
Toledo, OH 43606
Phone (419) 291-1111

1 Seagate
#800
Toledo, OH 43604
Phone (567) 585-1964

2940 N McCord Rd
Toledo, OH 43615
Phone (419) 842-3000

Interoperability endpoints

  • Direct secure messaging: kpruiett14139@direct.promedica.org

Organizations & group practices 13

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

View all 13

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1280102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773014400000",
    "number": "1649583139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2109 HUGHES DR # 720",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2109 HUGHES DR # 720",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063858",
            "telephone_number": "419-291-2077",
            "fax_number": "419-291-2122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUIETT",
        "first_name": "KELLEY",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-26",
        "last_updated": "2026-03-09",
        "certification_date": "2026-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "APRN.CNP.11612",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN-276458",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9384591",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMC",
            "identifier": "P00962317",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000671121",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3076442",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kpruiett14139@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "2109 Hughes Dr # 720",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436063858",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.