Provider Demographics
NPI:1760465744
Name:CHEWNING, KELLY MELINDA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MELINDA
Last Name:CHEWNING
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 1:25407 N COUNTY ROAD 1491
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-3459
Mailing Address - Country:US
Mailing Address - Phone:904-553-9818
Mailing Address - Fax:
Practice Address - Street 1:850 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE BUTLER
Practice Address - State:FL
Practice Address - Zip Code:32054-1353
Practice Address - Country:US
Practice Address - Phone:386-496-1922
Practice Address - Fax:386-496-2803
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN154325163W00000X
FLARNP9247953363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily