KELLY KAVANAUGH (NP) – Family Nurse Practitioner, NPI 1609257005

KELLY KAVANAUGH (NP) is a healthcare provider. based in Lorain, Ohio. specializing in NURSE PRACTITIONER. They hold the professional credentials NP. They hold a License No. 17368-NP (OH). The NPI Number for KELLY KAVANAUGH (NP) is 1609257005

Main info

Female
12 Years Of Experience
Accepts Medicare Assignment
Name
KELLY KAVANAUGH (NP)
NPI
1609257005
Phone
(440) 960-3237
Address
3600 Kolbe Rd
Enumeration Date
11 June 2015
Last Update Date
29 May 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4403240092
Graduation Year
2014 (12 years ago)
PAC ID
1254645336
Group Practice PAC ID
7416174701
Professional Enrollment ID
I20150803001864
Address ID
OH440352349EL710XXSTXX400
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience44
Completeness75
Years active:10State licenses:1Digital endpointsOther names

14,984 NURSE PRACTITIONER in OH

Provider Addresses for KELLY KAVANAUGH (NP)

  • 3600 Kolbe Rd

    Suite 209

    Lorain, OH 440531654

    Phone: (440) 960-3237

    Fax: (440) 960-3238

    Type: Location

  • PO BOX 636643

    CINCINNATI, OH 452636643

    Phone: (440) 989-3801

    Fax: (440) 960-3238

    Type: Mailing

  • 3600 KOLBE RD

    SUITE 209

    LORAIN, OH 440531654

    Phone: (440) 960-3237

    Fax: (440) 960-3238

    Type: Location

  • 710A LEONA ST

    ELYRIA, OH 440352349

    Phone: (440) 324-0092

    Fax: (440) 324-0093

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $77.

Total Amount is formed as General ($77) + Research ($0) + Ownership ($0) = $77.

Last reported payment date: 2023-05-25 • Largest payer in this snapshot: Lilly USA, LLC ($77).

Total Amount

$77

General + Research + Ownership

Payments

1

Total payment records

General Amount

$77

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-05-25

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
Lilly USA, LLC$77
View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2015-08-03

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20150803001864INurse PractitionerOHTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 44053)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 7416174701View full group profile
NameSpecialtyState
Physician AssistantOH
C H I R O P R A C T I COH

Reviews

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Frequently asked questions

What is the standard ID for KELLY KAVANAUGH (NP) in the U.S.?
In the U.S., KELLY KAVANAUGH (NP) is identified by NPI 1609257005.
Should I treat KELLY KAVANAUGH (NP) as an active provider?
Patients and plans typically see KELLY KAVANAUGH (NP) as active in the national extract.
How should patients interpret KELLY KAVANAUGH (NP)'s specialty?
The extract shows Family Nurse Practitioner for KELLY KAVANAUGH (NP). Clinical services aligned with this taxonomy classification.
What geographic area is tied to KELLY KAVANAUGH (NP)?
KELLY KAVANAUGH (NP) is associated with Lorain, Ohio in the same public data insurers reference.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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