Mary Kate Kelly, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

COA.12773-NP Issued in OH

Practice address

16600 W Sprague Rd
Suite 120
Middleburg Heights, OH 44130-6318

Phone

(440) 826-0500

Fax

(440) 826-0501

NPI assigned

Jul 21, 2011

Last updated

Apr 4, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

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  Adult Health

  NPD (past)
• Olmsted Health & Services Corp.

  dba Eliza Jennings Senior Care

  • Internal Medicine Physician
  • Olmsted Falls, OH
  • NPI 1851370647
  NPD (past)

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

{
    "created_epoch": "1311206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396569600000",
    "number": "1699053868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1239",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480991239",
            "telephone_number": "248-824-6600",
            "fax_number": "248-324-1477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16600 W SPRAGUE RD",
            "address_2": "SUITE 120",
            "city": "MIDDLEBURG HEIGHTS",
            "state": "OH",
            "postal_code": "441306318",
            "telephone_number": "440-826-0500",
            "fax_number": "440-826-0501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MARY",
        "middle_name": "KATE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-21",
        "last_updated": "2014-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "COA.12773-NP",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "RN209986",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasleen Kaur, OD
• Kci USA, Inc. (Solventum Advanced Wound Care)
• Molly Keeler
• Chelsea Kelligher
• Constance D Kelly, CRNP
• Saissy Kendig
• Kenneth L Basel DDS Inc
• Aimee E Kessick, LPC
• Kyle Kettler
• Jack Kidwell

• Nurse Practitioner in Middleburg Heights, OH
• Providers in Middleburg Heights, OH by specialty
• Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2014; 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.