| Doctor Name: | MRS. STACY SUE KELLEY |
| NPI Number: | 1174802938 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNP |
| License Number: | COA.12521 |
| Business Practice Address: | 6515 Pullman Dr Lewis Center, OH - 430357380 |
| Business Phone Number: | 6146887150 |
| Business Fax Number: | |
| Mailing Address: | 700 Ackerman Rd, Suite 260 COLUMBUS |
| State: | OH |
| Postal Code: | 432021559 |
| Phone Number: | 6149473700 |
| Fax Number: | 6149473771 |
| NPI Enumeration Date: | 08/11/2011 |
| NPI Last Update Date: | 01/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | COA.12521 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |