Provider Demographics
NPI:1881648772
Name:KELLY, KAREN ELIZABETH (ARNP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ELIZABETH
Last Name:KELLY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:K
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:226 CRANES LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-1616
Mailing Address - Country:US
Mailing Address - Phone:904-373-0179
Mailing Address - Fax:
Practice Address - Street 1:226 CRANES LAKE DR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-1616
Practice Address - Country:US
Practice Address - Phone:904-373-0179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9267273363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P18638Medicare UPIN