Provider Demographics
NPI:1033750997
Name:STELLING, KELLY MARIE (CNA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:STELLING
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 22ND ST
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3245
Mailing Address - Country:US
Mailing Address - Phone:850-517-5232
Mailing Address - Fax:
Practice Address - Street 1:308 22ND ST
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-3245
Practice Address - Country:US
Practice Address - Phone:850-517-5232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL373396376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS345513846770Medicaid