Provider Demographics
NPI:1568658383
Name:RIOS, KELLY JANE (APRN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JANE
Last Name:RIOS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3487 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7213
Mailing Address - Country:US
Mailing Address - Phone:239-334-9555
Mailing Address - Fax:239-334-2832
Practice Address - Street 1:3487 BROADWAY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7213
Practice Address - Country:US
Practice Address - Phone:239-334-9555
Practice Address - Fax:239-334-2832
Is Sole Proprietor?:No
Enumeration Date:2007-09-16
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9226866363LA2100X
OH13219-NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012123700Medicaid