Provider Demographics
NPI:1871997312
Name:RHOADES, KELLEY (NP)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:RHOADES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 BETHESDA DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-7507
Mailing Address - Country:US
Mailing Address - Phone:740-450-1687
Mailing Address - Fax:740-450-1693
Practice Address - Street 1:945 BETHESDA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-0801
Practice Address - Country:US
Practice Address - Phone:740-454-4788
Practice Address - Fax:740-450-6157
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.16629-NP364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCOA.16629-NPOtherOHIO LICENSURE