Provider Demographics
NPI:1033126412
Name:CREWS, KELLY (ARNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:CREWS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:601 S FLORIDA AVE
Mailing Address - Street 2:#6
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5237
Mailing Address - Country:US
Mailing Address - Phone:863-688-0841
Mailing Address - Fax:863-616-9709
Practice Address - Street 1:601 S FLORIDA AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5237
Practice Address - Country:US
Practice Address - Phone:863-688-0841
Practice Address - Fax:863-616-9709
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9170779363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP 9170779OtherARNP LICENSE NUMBER
FL305346600Medicaid