Provider Demographics
NPI:1801248281
Name:ROBERTS, KELLY KRIEGER (ARNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:KRIEGER
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 E EDGEWOOD DR STE 112
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-3639
Mailing Address - Country:US
Mailing Address - Phone:863-666-3436
Mailing Address - Fax:863-667-3550
Practice Address - Street 1:2000 E EDGEWOOD DR STE 112
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3639
Practice Address - Country:US
Practice Address - Phone:863-666-3436
Practice Address - Fax:863-667-3550
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9356431363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health