Healthcare Provider Details

I. General information

NPI: 1659334126
Provider Name (Legal Business Name): JEFFERY SCOTT KELLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14088 ALABAMA STREET
JAY FL
32565-1036
US

IV. Provider business mailing address

PO BOX 10 14088 ALABAMA STREET
JAY FL
32565-1036
US

V. Phone/Fax

Practice location:
  • Phone: 850-675-4546
  • Fax: 850-675-4548
Mailing address:
  • Phone: 850-675-4546
  • Fax: 850-675-4548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME81689
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: