Provider Demographics
NPI:1720223605
Name:POWELL, KELLY E (APRN-C)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:E
Last Name:POWELL
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:E
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP-C
Mailing Address - Street 1:14100 FIVAY RD STE 265
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7151
Mailing Address - Country:US
Mailing Address - Phone:727-819-2945
Mailing Address - Fax:727-819-2970
Practice Address - Street 1:14100 FIVAY RD
Practice Address - Street 2:SUITE 280
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7180
Practice Address - Country:US
Practice Address - Phone:727-819-2945
Practice Address - Fax:727-819-2970
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3085712363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023965429Medicaid
FL023965429Medicaid