Provider Demographics
NPI:1811979461
Name:CROSS, KELLI A (MD)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:A
Last Name:CROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5033 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8240
Mailing Address - Country:US
Mailing Address - Phone:727-334-8523
Mailing Address - Fax:727-292-1164
Practice Address - Street 1:5033 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8240
Practice Address - Country:US
Practice Address - Phone:727-334-8523
Practice Address - Fax:727-292-1164
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071388208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
41684OtherBCBS
FL251770100Medicaid