Provider Demographics
NPI:1457728297
Name:KELLY, KRISTY HENNING (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:HENNING
Last Name:KELLY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:KRISTY
Other - Middle Name:LEIGH
Other - Last Name:HENNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:9098 VICKROY TERRACE
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765
Mailing Address - Country:US
Mailing Address - Phone:407-325-8671
Mailing Address - Fax:
Practice Address - Street 1:1245 ORANGE AVE STE 120
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4954
Practice Address - Country:US
Practice Address - Phone:407-478-4585
Practice Address - Fax:407-366-2559
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9321408363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily