Provider Demographics
NPI:1891942207
Name:MCCRAY, KELLI CHARLENE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:CHARLENE
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:5400 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-3833
Mailing Address - Country:US
Mailing Address - Phone:352-277-5305
Mailing Address - Fax:352-616-0926
Practice Address - Street 1:5350 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4562
Practice Address - Country:US
Practice Address - Phone:352-688-3379
Practice Address - Fax:352-398-1333
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2023-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH311372163W00000X
FLRN9245619363LF0000X
FLAPRN11027047363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2094273Medicaid