Provider Demographics
NPI:1750500252
Name:KELLY, MARGARET MARY (ARNP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARY
Last Name:KELLY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 150TH AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33706
Mailing Address - Country:US
Mailing Address - Phone:727-507-4673
Mailing Address - Fax:727-507-4799
Practice Address - Street 1:13800 66TH ST
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771
Practice Address - Country:US
Practice Address - Phone:727-507-4203
Practice Address - Fax:727-544-4015
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP888372363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303106300Medicaid
FL303106300Medicaid
FLE4356ZMedicare ID - Type Unspecified
FLP10581Medicare UPIN