Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | APRN.CNP.021539 | OH |
NPI | 1003332040 |
---|---|
Provider Name | Mrs. Kelly Ann Labra |
First Address | Youngstown, OH 44512-5062 |
Second Address | Youngstown, OH 44512-5062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2017 |
Last Update Date | 09/02/2022 |