MEDICARE: MS. VENDA KELLEY 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	363LF0000X	Family Nurse Practitioner	ARNP9429926	FL
2	363LF0000X	Family Nurse Practitioner	3672P	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	500026005	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2237571	OTHER		CCN
2	C60195	OTHER		CUMBERLAND HEALTHCARE
3	000000226588	OTHER	KY	ANTHEM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	A574	OTHER	KY	BC/BS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	6EFGA	OTHER	FL	BLUS CROSS BLUE SHIELD
8	1191652	OTHER	KY	CHA
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841294709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VENDA KELLEY ARNP

Provider Business Mailing Address
First Line	:	3434 HANCOCK BRIDGE PKWY
Second Line	:	STE. 301
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-7094
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:	239-599-2612

Provider Business Practice Location Address
First Line	:	2450 TAMIAMI TRL
Second Line	:	STE A
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-3922
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:	239-599-2612

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	10/11/2016

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