Provider Demographics
NPI:1053483750
Name:ADAMS, KELLY LYNN (DO)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5722 S FLAMINGO RD
Mailing Address - Street 2:#273
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-3206
Mailing Address - Country:US
Mailing Address - Phone:954-609-9001
Mailing Address - Fax:
Practice Address - Street 1:5722 S FLAMINGO RD
Practice Address - Street 2:#273
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330-3206
Practice Address - Country:US
Practice Address - Phone:954-609-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 9082207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine