Healthcare Provider Details

I. General information

NPI: 1013771922
Provider Name (Legal Business Name): KELLY LIANG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 LANTANA RD STE 100
LAKE WORTH FL
33462-1304
US

IV. Provider business mailing address

3450 LANTANA RD STE 100
LAKE WORTH FL
33462-1304
US

V. Phone/Fax

Practice location:
  • Phone: 561-965-1864
  • Fax: 561-967-5005
Mailing address:
  • Phone: 561-965-1864
  • Fax: 561-967-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11031910
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: