Healthcare Provider Details

I. General information

NPI: 1891313334
Provider Name (Legal Business Name): KELLIE L HERRINGTON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 N WICKHAM RD
MELBOURNE FL
32935-8662
US

IV. Provider business mailing address

7415 TROPICANA AVE
MELBOURNE FL
32904-1607
US

V. Phone/Fax

Practice location:
  • Phone: 321-541-1777
  • Fax: 321-541-1786
Mailing address:
  • Phone: 321-615-7287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN9369293
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11008278
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: