Cervenka, Kelly R

Cervenka, Kelly R is an sole proprietor health care provider with primary practice located at 4229 Pearl Rd , Cleveland OH 44109-4218. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Cervenka, Kelly R can be contacted via phone (216) 205-4026.

Contact Information

Primary practice address
4229 Pearl Rd Cleveland OH 44109-4218
Phone: (216) 205-4026
Fax: (216) 205-4032
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X RN211663 Ohio
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X COA.04944-NP Ohio

Profile Details

NPI number 1871587808
LBN Legal business name Cervenka, Kelly R
Credentials Certified Nurse Practitioner (CNP)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 6th, 2005
Last updated Aug 30th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871587808 NPPES
Ohio MEDICAID 2343655

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