Healthcare Provider Details

I. General information

NPI: 1245100643
Provider Name (Legal Business Name): KELLYN DANIEL CURRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3D RECON BN
FPO AP
96388-8002
US

IV. Provider business mailing address

3D RECON BN
FPO AP
96388-8002
US

V. Phone/Fax

Practice location:
  • Phone: 315-625-7036
  • Fax:
Mailing address:
  • Phone: 315-625-7036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number08243550KC
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: