Healthcare Provider Details

I. General information

NPI: 1881510428
Provider Name (Legal Business Name): KELLYS FAMILY HEALTHCARE-NP IN FAMILY HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 FULFORD ST
DELTONA FL
32738-3037
US

IV. Provider business mailing address

2812 FULFORD ST
DELTONA FL
32738-3037
US

V. Phone/Fax

Practice location:
  • Phone: 518-379-6363
  • Fax: 949-886-0645
Mailing address:
  • Phone: 518-379-6363
  • Fax: 949-886-0645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LUZ M KELLY
Title or Position: PROVIDER/OWNER
Credential: FNP
Phone: 518-379-6363