Healthcare Provider Details

I. General information

NPI: 1437867595
Provider Name (Legal Business Name): NORAH J.M. KELLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S PARK RD STE 200
HOLLYWOOD FL
33021-8541
US

IV. Provider business mailing address

41 FALLEN OAK LN
PALM COAST FL
32137-9132
US

V. Phone/Fax

Practice location:
  • Phone: 866-986-2263
  • Fax:
Mailing address:
  • Phone: 386-290-2866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11021137
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: