Provider Demographics
NPI:1841006814
Name:KELLY, ADEL MARIE (NP)
Entity type:Individual
Prefix:
First Name:ADEL
Middle Name:MARIE
Last Name:KELLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-5314
Mailing Address - Country:US
Mailing Address - Phone:850-740-5010
Mailing Address - Fax:850-804-1705
Practice Address - Street 1:1931 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-5314
Practice Address - Country:US
Practice Address - Phone:904-515-2656
Practice Address - Fax:850-804-1705
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11036477363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner