MEDICARE: MRS. KELLY E POWELL-GRIM APRN-C

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	363LA2200X	Adult Health Nurse Practitioner	3085712	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720223605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY E POWELL-GRIM APRN-C

Provider Business Mailing Address
First Line	:	9488 HERNANDO RIDGE RD
Second Line	:
City	:	WEEKI WACHEE
State	:	FL
Zip	:	34613-6446
Country	:	US
Telephone Number	:	727-819-2945
Fax Number	:	727-819-2970

Provider Business Practice Location Address
First Line	:	14100 FIVAY RD STE 265
Second Line	:
City	:	HUDSON
State	:	FL
Zip	:	34667-7151
Country	:	US
Telephone Number	:	727-819-2945
Fax Number	:	727-819-2970

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

Provider Enumeration Date	:	12/08/2008
Last Update Date	:	04/16/2025

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Directions to “ MRS. KELLY E POWELL-GRIM APRN-C” Practice Location

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