Healthcare Provider Details

I. General information

NPI: 1033126412
Provider Name (Legal Business Name): KELLY CREWS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY STEWART ARNP

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S FLORIDA AVE SUITE 6
LAKELAND FL
33801-5237
US

IV. Provider business mailing address

601 S FLORIDA AVE #6
LAKELAND FL
33801-5237
US

V. Phone/Fax

Practice location:
  • Phone: 863-688-0841
  • Fax: 863-616-9709
Mailing address:
  • Phone: 863-688-0841
  • Fax: 863-616-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9170779
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: