Provider Demographics
NPI:1235284951
Name:MAHANY, KELLY ERIN (ARNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ERIN
Last Name:MAHANY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 WOOD CHUCK AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-7520
Mailing Address - Country:US
Mailing Address - Phone:727-946-6343
Mailing Address - Fax:
Practice Address - Street 1:5637 MARINE PKWY
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4316
Practice Address - Country:US
Practice Address - Phone:727-834-5644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1470572363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal