Provider Demographics
NPI:1881096766
Name:WARKENTIN, KELLY E (MHA, CADC-II)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:E
Last Name:WARKENTIN
Suffix:
Gender:F
Credentials:MHA, CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1824
Mailing Address - Country:US
Mailing Address - Phone:479-981-2543
Mailing Address - Fax:
Practice Address - Street 1:409 E PLEASANT ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1824
Practice Address - Country:US
Practice Address - Phone:479-981-2543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1881096766Medicaid