Provider Demographics
NPI:1679911200
Name:MORRELL, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MORRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9245
Mailing Address - Street 2:
Mailing Address - City:MASARYKTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:34604-0245
Mailing Address - Country:US
Mailing Address - Phone:352-232-2522
Mailing Address - Fax:352-754-1756
Practice Address - Street 1:14180 AMERO LN
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-6213
Practice Address - Country:US
Practice Address - Phone:352-593-4487
Practice Address - Fax:352-345-4736
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility