Provider Demographics
NPI:1174379994
Name:HAMMONS, KELLI (CPRS)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:HAMMONS
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 MINSTER ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-3154
Mailing Address - Country:US
Mailing Address - Phone:513-291-6386
Mailing Address - Fax:
Practice Address - Street 1:234 MINSTER ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-3154
Practice Address - Country:US
Practice Address - Phone:513-291-6386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.004009175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist