Provider Demographics
NPI:1467824904
Name:KELLY, TRACIAN PATRICE (ARNP)
Entity Type:Individual
Prefix:
First Name:TRACIAN
Middle Name:PATRICE
Last Name:KELLY
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 1:1650 OSCEOLA DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-5038
Mailing Address - Country:US
Mailing Address - Phone:561-803-8880
Mailing Address - Fax:877-409-1795
Practice Address - Street 1:1650 OSCEOLA DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-5038
Practice Address - Country:US
Practice Address - Phone:561-803-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9271088363LF0000X
FL2020001370363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily