Healthcare Provider Details

I. General information

NPI: 1881526374
Provider Name (Legal Business Name): KELLY ANDERSON MLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4039 NEWBERRY RD
GAINESVILLE FL
32607-2342
US

IV. Provider business mailing address

14619 NW 21ST PL
NEWBERRY FL
32669-2041
US

V. Phone/Fax

Practice location:
  • Phone: 352-224-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License NumberSU44843
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: