Provider Demographics
NPI:1629225289
Name:KERNAGHAN, KELLY IRENE (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:IRENE
Last Name:KERNAGHAN
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:IRENE
Other - Last Name:CALLEGARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC/SLP
Mailing Address - Street 1:7657 CITA LN
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6221
Mailing Address - Country:US
Mailing Address - Phone:727-376-1111
Mailing Address - Fax:727-376-1113
Practice Address - Street 1:7657 CITA LN
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6221
Practice Address - Country:US
Practice Address - Phone:727-376-1111
Practice Address - Fax:727-376-1113
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1840235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL880475300Medicaid
FLBX726ZOtherMEDICARE