Provider Demographics
NPI:1154483956
Name:KELLEY, KRISTEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:SZYSLOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 748519
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8519
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:904-376-3998
Practice Address - Street 1:98 NOCATEE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32081-6152
Practice Address - Country:US
Practice Address - Phone:904-376-3800
Practice Address - Fax:904-390-7392
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20211103TC0700X
FLPY8745103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHH051ZMedicare PIN