Tracy Kellam

Contractor · Youngstown, OH

Individual Active NPI

NPI number 1104498344

Practice location

4120 Euclid Blvd
Youngstown, OH 44512-1305
Phone
(330) 984-1505

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NPI record

NPI
1104498344
Entity type
Individual (Type 1)
Enumeration date
July 16, 2021
Last updated
July 16, 2021
Certified
July 16, 2021
Sole proprietor
Yes

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Contractor Primary 171W00000X 0325993 OH

About Tracy Kellam

Tracy Kellam is a healthcare provider registered in the NPI registry with the primary taxonomy Contractor (code 171W00000X). The practice location is 4120 Euclid Blvd, Youngstown, OH 44512-1305. The NPI number 1104498344 was assigned on July 16, 2021 and the record was last updated on July 16, 2021.

Tracy Kellam lists a license in the registry: #0325993 (OH) for Contractor. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Tracy Kellam?

The NPI number is 1104498344.

What is the phone number of Tracy Kellam?

The phone number listed for the practice location is (330) 984-1505.

Where is Tracy Kellam located?

4120 Euclid Blvd, Youngstown, OH 44512-1305.

What is the taxonomy code for Tracy Kellam?

The primary taxonomy code is 171W00000X – Contractor.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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