Provider Demographics
NPI:1811188618
Name:KELLY, KRISTIN LUEBBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:LUEBBERT
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:LUEBBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1255 37TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6550
Mailing Address - Country:US
Mailing Address - Phone:772-564-2485
Mailing Address - Fax:772-564-6132
Practice Address - Street 1:1255 37TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6550
Practice Address - Country:US
Practice Address - Phone:772-564-2485
Practice Address - Fax:772-564-6132
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0092614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine