Provider Demographics
NPI:1376968032
Name:KELLNER, CORI DEVON (ARNP, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:CORI
Middle Name:DEVON
Last Name:KELLNER
Suffix:
Gender:F
Credentials:ARNP, WHNP-BC
Other - Prefix:
Other - First Name:CORI
Other - Middle Name:DEVON
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP, WHNP-BC
Mailing Address - Street 1:1223 GATEWAY DR
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2607
Mailing Address - Country:US
Mailing Address - Phone:321-725-4500
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:1223 GATEWAY DR
Practice Address - Street 2:SUITE 1D
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2607
Practice Address - Country:US
Practice Address - Phone:321-725-4500
Practice Address - Fax:321-729-6166
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9276319363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012030200Medicaid
FLHV980ZMedicare UPIN