MEDICARE: KELLY EILEEN JEAN-LOUIS ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0041310	OH
2	363LF0000X	Family Nurse Practitioner	ARNP9301051	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275086886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY EILEEN JEAN-LOUIS ARNP

Provider Business Mailing Address
First Line	:	4805 BARBADOS LOOP
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-5400
Country	:	US
Telephone Number	:	407-269-4935
Fax Number	:

Provider Business Practice Location Address
First Line	:	4805 BARBADOS LOOP
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-5400
Country	:	US
Telephone Number	:	407-269-4935
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2016
Last Update Date	:	03/03/2026

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