Individual
KRISTIN LEE KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3928 S NOVA RD, PORT ORANGE, FL 32127-4911
(386) 822-9941
(386) 788-4519
Mailing address
3780 CLYDE MORRIS BLVD APT 603, PORT ORANGE, FL 32129-8202
(303) 564-3629
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5235826
FL
Other
Enumeration date
11/04/2021
Last updated
11/04/2021
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