Provider Demographics
NPI:1689661399
Name:TRENT, KELLEY A (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:A
Last Name:TRENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9143 PHILIPS HWY
Mailing Address - Street 2:STE 560
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-1348
Mailing Address - Country:US
Mailing Address - Phone:904-363-7453
Mailing Address - Fax:904-538-3672
Practice Address - Street 1:2161 KINGSLEY AVE
Practice Address - Street 2:STE 200
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5113
Practice Address - Country:US
Practice Address - Phone:904-272-3139
Practice Address - Fax:904-276-7374
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 61231207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32426OtherBCBS
FLG43454Medicare UPIN
FL32426OtherBCBS
FL32426XMedicare ID - Type Unspecified