Provider Demographics
NPI:1255597670
Name:ARMSTRONG, KELLY C (APRN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:C
Last Name:ARMSTRONG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 LAKE DAVENPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-9440
Mailing Address - Country:US
Mailing Address - Phone:863-256-5030
Mailing Address - Fax:
Practice Address - Street 1:115 LAKE DAVENPORT BLVD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897-9440
Practice Address - Country:US
Practice Address - Phone:863-256-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110976363LA2200X
FLAPRN9481079363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE59385OtherRN