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NPI Code Detail

MEDICARE: KELLY J CRAGETT- KNOWLES APRN

MEDICARE: KELLY J CRAGETT- KNOWLES APRN
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
1363L00000XNurse PractitionerAPRN9212525FL
2363LG0600XGerontology Nurse PractitionerAPRN9212525FL

Other Identifiers

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

General Provider Information

NPI Number : 1710483771
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY J CRAGETT- KNOWLES APRN
Provider Business Mailing Address
First Line : PO BOX 102222
Second Line :
City : ATLANTA
State : GA
Zip : 30368-2222
Country : US
Telephone Number : 239-274-8200
Fax Number :
Provider Business Practice Location Address
First Line : 3525 LAKLEAND HILLS BLVD
Second Line :
City : LAKELAND
State : FL
Zip : 33805-1965
Country : US
Telephone Number : 863-603-6565
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2018
Last Update Date : 01/21/2026

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